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PubMed2001

Is there equity in access to health services for ethnic minorities in Sweden?

BACKGROUND: This paper addresses the extent to which equity of treatment according to need, as defined by self-reported health status, is received by members of ethnic minorities in Swedish health services. METHODS: The study was based on a multivariate analysis of cross-sectional data from the Swedish Survey of Living Conditions and Immigrant Survey of Living Conditions in 1996 on use of health services, morbidity and socioeconomic indicators. The study population consisted of 1,890 Swedish residents aged 27-60 years born in Chile, Poland, Turkey and Iran and 2,452 age-matched, Swedish-born residents. MAIN RESULTS: Residents born in Chile, Iran and Turkey were more likely to have consulted a physician during the 3 months prior to the interview compared to Swedish-born residents; odds ratios (ORs) 1.4 (95% CI: 1.2-1.7), 1.3 (95% CI: 1.1-1.7) and 1.5 (95% CI: 1.3-1.9) respectively. The higher consultation rate in these ethnic minorities was primarily explained by a less satisfactory, self-reported health status compared to Swedish-born residents. Thirty-eight percent of the minority study groups reported exposure to organised violence in their country of origin, which was associated with a higher level of use of consultations with a physician (OR 1.3, 95% CI: 1.1-1.6). CONCLUSIONS: This study did not indicate any gross pattern of inequity in access to care for ethnic minorities in Sweden. Systems for allocating resources to health authorities need to consider the possibility that ethnic minorities in Sweden and in particular victims of organised violence, use health services more than is suggested by socioeconomic indicators only.

Adolescent↗
PubMed2001

Highly active antiretroviral therapy (HAART). Awareness and beliefs about infectivity and the influence on sexual behaviour in the general population of Sweden.

The purpose of the present study was to assess the relationship between the awareness of HAART, beliefs regarding transmission of HIV of persons taking HAART, norms associated with sexual risk behaviour, fear of HIV/AIDS, optimism of finding a cure or vaccine, and sexual behaviour in the general population of Sweden. A mail survey was sent to 4,000 randomly selected individuals aged 16-44 years. The study shows that the general public of Sweden is aware of HAART. Only 15% of the population had never heard of HAART. Eight percent believed that those taking HAART were 'no longer' or 'less' infective. Those not aware of HAART reported greater fear of HIV infected persons, less volunteer testing for HIV, and more sexual partners. Those who believed that persons taking HAART were less infective reported greater fear, more optimism concerning the possibilities to find a cure or vaccine, and had more discussions regarding HIV. We conclude that a group that may be at increased risk of HIV infection may be persons who are not aware of HAART or believe that persons are no longer infective when taking HAART. These persons may be an additional target group for HIV prevention.

Adolescent↗
PubMed2002

Alcohol-related deaths contribute to socioeconomic differentials in mortality in Sweden.

BACKGROUND: This study aims at estimating the contribution of alcohol to socioeconomic mortality differentials in Sweden. METHODS: Data were obtained from a Census-linked Deaths Registry. Participants in the 1980 and 1990 censuses were included with a follow-up of mortality 1990-1995. Socioeconomic status was assigned from occupation in 1990 or 1980. Alcohol-related deaths were defined from underlying or contributory causes. Poison regressions were applied to compute age-adjusted mortality rate ratios for all-causes, alcohol-related and other causes among 30-79-year-olds. The contribution of alcohol to mortality differentials was calculated from absolute differences. RESULTS: Around 5% (9,547) of all deaths were alcohol-related (30-79 years). For both sexes, manual workers, lower nonmanuals, entrepreneurs and unclassifiable groups had significantly higher alcohol-related mortality than did upper nonmanuals. Male farmers had significantly lower such mortality. The contribution of alcohol to excess mortality over that of upper nonmanuals was greatest among middle-aged (40-59 years) men who were manual workers or who belonged to a group of 'unclassifiable & others' (25-35%). It was of considerable size also for middle-aged lower nonmanuals (both sexes), male entrepreneurs, female manual workers and 'unclassifiable & others'. Among men, the total contribution of alcohol (30-79 years) was estimated at 16% for manual workers, 10% for lower nonmanuals and 7% for entrepreneurs; and among women, 6% (manual workers, lower nonmanuals) and 3% (entrepreneurs). CONCLUSION: Although deaths related to alcohol were probably underreported (e.g. accidents), alcohol clearly contributes to socioeconomic mortality differentials in Sweden. The size of this contribution depends strongly on age (peak among the middle-aged) and gender (greatest among men).

Adult↗
PubMed2002

'Avoidable' mortality among immigrants in Sweden.

BACKGROUND: The concept of studying 'avoidable' mortality as an indicator of the outcome of health care has been applied mainly in studies of time-trends and geographical and socio-economic variation. METHODS: In this study, indicators of 'avoidable' mortality among immigrants in Sweden have been studied. Comparisons of death rates among immigrants and those born in Sweden were made using a linkage of the Population Census and the Cause of Death Register, nationwide sources. RESULTS: For a group of health policy indicators, such as liver cirrhosis and malignant neoplasms of the trachea, bronchus and lung, death rates were about 40-100% higher among immigrants from other Nordic countries, Yugoslavia and Eastern Europe than among the Swedish born population. For causes of death considered amenable to medical care intervention there were, however, small differences. For some conditions, such as cerebrovascular disease, malignant neoplasms of colon and rectum, chronic bronchitis and emphysema, high death rates were found among immigrants from other Nordic countries. For immigrants from other countries, there were no high death rates based on medical care indicators when compared to the Swedish-born population. CONCLUSION: There were few indications of inequity reflected in the mortality outcome of medical care. The variation found in death rates from health policy indicators may reflect differences in smoking and alcohol habits.

Adult↗
PubMed2001

Does engagement with life enhance survival of elderly people in Sweden? The role of social and leisure activities.

OBJECTIVES: This research examined whether engagement with life, defined as involvement in social, leisure, and productive activities, produced a survival advantage among oldest old persons in Sweden. Survival was investigated with respect to activities that involved (a) social integration, (b) physical mobility, and (c) neither social nor physical aspects. The authors also investigated the degree to which any observed survival benefits were related to prior health differences that select older adults into active roles. METHODS: Baseline data derived from the Swedish Panel Study of Living Conditions of the Oldest Old, a nationally representative sample of persons aged 77 years and older living in Sweden in 1992. The authors used factor analysis to apply a simplifying measurement structure to frequency of participation in 10 leisure activities. They used Cox proportional hazard regression to estimate the relative effects of activity factors and other independent variables on the logged hazard rate of mortality up to 1996. RESULTS: Analyses revealed 4 domains of activities that lie along 2 basic dimensions: solitary-social and sedentary-active. Among men, only participation in activities that were both solitary and active was significantly associated with reduced mortality risk when health variables were controlled. Among women, none of the activity domains was significant when health variables were controlled. For the entire sample, greater participation in solitary-active activities significantly reduced risk of mortality when all other activity domains and health factors were controlled. DISCUSSION: Although most of the observed associations between activity involvement and survival are a byproduct of the confound between poor initial health and low activity levels, solitary activities have a positive influence on the survival of very old individuals, especially men, suggesting that nonsocial aspects of activities may promote health and longevity in late old age.

Activities of Daily Living↗
PubMed1987

Health promotion policy in Sweden: means and methods in intersectoral action.

In Sweden different commissions have been working on legislation, prevention programmes and financing, and have aimed at implementing the Health For All strategy at national level. National programmes for cardiovascular diseases, cancer, accidental injuries, etc were established by parliamentary resolution in 1985. The role of health education has been extended: from the earlier concern with matters of individual lifestyle the focus has shifted towards motivating the community as a whole to take an active interest in its health. There is good public support in the areas of legislation, knowledge and awareness, international development (WHO), and public policy. Despite the existence of legislation, strong official policy and a good organizational structure, strong efforts are still needed to turn health promotion into general practice. National, regional and local bodies as well as non-governmental and private organizations are showing an increasing interest in health promotion. Health promotion strategies are used in traditional fields such as alcohol and smoking as well as other sectors such as education, employment, culture, social welfare, town and house planning, transport and environmental protection. There has never been such a positive basis for the further development of health promotion policy in Sweden though there are a number of potential conflicts and problems related to knowledge, organization, attitudes, financing, distribution of power, etc. These are outlined broadly as "The organizational trap", "Modification or revolution?" and "Individual or public responsibility for health?".

Government Agencies↗
PubMed2005

Bicycle helmet use in Sweden during the 1990s and in the future.

This paper describes how the use of bicycle helmets in Sweden has changed for different categories of cyclists from 1988 to 2002, and it also estimates future trends in voluntary wearing of bicycle helmets up to the year 2010. Observational studies of the use of bicycle helmets were conducted once a year from 1988 to 2002 at 157 sites in 21 cities. The subjects observed were children cycling to school (average n = 5471/year) and in their free time (average n = 2191/year), and adults cycling to workplaces and on public bike paths (average n = 29 368/year). The general trend in helmet use from 1988 to 2002 was determined by linear regression analysis, and the results were also employed to estimate future helmet wearing for the period 2003-2010. Differences in helmet use according to gender and size of city were analysed by chi-square tests. From 1988 to 2002, all categories of cyclists showed an upward trend in helmet use (p < 0.01, p < 0.001). Helmet wearing increased from about 20 to 35% among children (< or =10 years) cycling during free time, from approximately 5 to 33% among school children, and from around 2 to 14% in adults. Total average helmet use rose from about 4 to 17%. However, during the last 5 years of the study period (1998-2002), none of the categories of cyclists studied showed an upward trend in helmet wearing. It is estimated that approximately 30% of cyclists will wear helmets voluntarily by the year 2010, if helmet promotion activities are continued at the same level as previously. The results suggest that Sweden will probably not reach its official goal of 80% helmet use unless a national bicycle helmet law is passed.

Adolescent↗
PubMed1999

Regional differences in waiting time to pregnancy: pregnancy-based surveys from Denmark, France, Germany, Italy and Sweden. The European Infertility and Subfecundity Study Group.

The objective of this study was examine geographical variation in couple fecundity in Europe. The study was based upon all recently pregnant (or still pregnant) women within well-defined geographical areas in Europe (Denmark, Germany, Italy, Sweden and France) at a given time period in 1992. Altogether, 4035 women responded to a highly structured questionnaire. Highest fecundity was found in Southern Italy and Northern Sweden; lowest fecundity was seen in data from the East German centre. Approximately 16% of the study population had a waiting time of more than 12 months to become pregnant. Most of the pregnancies were planned (64%) and approximately 14% were the result of contraceptive failures. The study shows that smoking, body mass index, age and parity did not explain the differences in fecundity found between the centres. Regional differences in fecundity exist and the causes may be genetic or due to variations in behavioural and environmental exposures.

Adult↗
PubMed1982

Cigarette smoking and alcohol use in Finland and Sweden: a cross-national twin study.

Cigarette smoking and alcohol use habits in Finland and Sweden were studied using data from the Finnish and Swedish studies on like-sexed adult twin pairs aged 18-47 (total of 20 056 pairs). Finnish men were heavier consumers of tobacco and alcohol than Swedish men. When heavy consumers (greater than 500g of alcohol/month and greater than 20 cigarettes/day) were considered, the prevalence rate was 9.7% in Finnish men and 5.1% in Swedish men. This difference might account for the higher morbidity in Finland than in Sweden from many smoking- and alcohol-associated diseases. Genetic factors in smoking and alcohol use were assessed by comparing observed and expected coincidence rates, and by multivariate analyses. Genetic and familial effects were defined as an excess coincidence in monozygotic (MZ) pairs compared to dizygotic (DZ) pairs, and by an increased DZ coincidence rate compared to that expected. Significant genetic and familial effects were observed for cigarette smoking, and for smoking more than one pack of cigarettes a day. Significant familial effects for alcohol use was observed, and a significant genetic effect was obtained for men. A significant genetic effect could not be observed for the combined heavy use of alcohol and heavy smoking. The genetic and familial effects seemed to be mostly independent of country and sex.

Adult↗
PubMed1985

Evaluation of screening for cervical cancer in Sweden: trends in incidence and mortality 1958-1980.

Papanicolaou screening for cancer of the uterine cervix was introduced in Sweden in the late 1950's. Screening programmes covering the age groups 30-49 years were organized in various countries between 1965 and 1973. The approximate number of smears rose from 100 000 in 1960 to one million in 1970, in a female population of four million. Almost 60 000 cases of in situ carcinoma and 17 100 invasive carcinomas of the uterine cervix were registered in Sweden between 1958 and 1980. The age-standardized incidence of invasive carcinoma fell in this period by about 40%. Within the screened cohorts and age groups, the incidence was reduced by two-thirds and there was a parallel fall in mortality from the disease. At least part of these reductions seemed to be explained by the intensity of screening.

Adult↗
PubMed1992

Assessing the extent of the HIV epidemic in Sweden, using information on the extent to which people who develop AIDS are already known to be HIV infected.

In Sweden, cases of both HIV infection and AIDS are registered. By looking at the extent to which people who develop AIDS are already known to be HIV-infected, we can assess the coverage of the HIV registration. It was found that virtually all those who were infected by injecting themselves with drugs, blood transfusions, blood products or congenitally were already known to be infected when AIDS developed. However, when homosexual or heterosexual transmission had occurred, 20.5% and 33.3% respectively of these cases were not previously known. Working with different assumptions regarding the development of the epidemic, we find that the true number of sexually infected people is roughly twice the number of registered HIV-infected people in these groups. Our estimate is that between 3300 and 6300 people were infected with HIV in Sweden up till the end of 1990.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Incidence of myocardial infarction and mortality from specific causes among bus drivers in Sweden.

Previous studies have indicated that urban bus drivers have an increased risk of coronary heart disease. In the present investigation two separate studies were carried out. In the first study the mortality from myocardial infarction (MI), as well as from other causes for all male bus drivers in Sweden (9446), was investigated and compared to those of other employed men over a 15-year period. A 50% increase in mortality from MI was observed among drivers in Stockholm and Göteborg and Bohus counties, the two counties where the two largest cities in Sweden are situated. No increased mortality from lung cancer, any cancer (all sites combined), or from all causes combined was observed for these drivers. For bus drivers in the predominantly rural areas no excess mortality from MI, or any other cause, was observed. In the second study the incidence of MI among male bus drivers, as compared with other employed men, was studied in five Swedish counties by case referent methods. An increased incidence of first events of MI, (relative risk = 1.6, 95% confidence interval (CI) 1.1-1.9) was observed for bus drivers in Stockholm county. According to our results, urban bus drivers thus have an increased risk of developing MI. The findings also suggest that factors in the work environment of urban bus drivers may contribute to this increased risk. Factors of possible importance are job strain, irregular working hours, a sedentary job, automobile exhaust fumes, and noise.

Automobile Driving↗
PubMed1995

Systematic small-area variation in mortality for malignant neoplasms in Sweden 1975-1990.

BACKGROUND: Cancer mortality has been stated to be the best single measure of progress in combatting cancer. The variation in total and cause-specific cancer mortality among health administrative areas in Sweden was analysed in order to find out if the mortality outcome has been equally distributed. METHODS: Data on underlying causes of death for ages 0-74 years were analyzed for the 26 health administrative areas in Sweden, 1975-1990. Analyses of systematic (non-random) variance were performed and measures chosen in order to make comparisons possible between different malignant neoplasms and different periods of time. RESULTS: The systematic variance for all malignant neoplasms was reduced by about 40% during the study period. The largest systematic variations in mortality were found for cancer of the oesophagus and lung, although the systematic variation for these neoplasms was lower in the 1980s than in the 1970s. Large systematic variation was also found for cancer of the cervix uteri and of the bladder. For these causes the variation remained constant throughout the period. CONCLUSIONS: Generally speaking, the outcome of cancer has become more equally distributed across the country. Preventive measures should be possible for the malignant neoplasms with the largest regional variation.

Female↗
PubMedDate not supplied

Drinking drivers in Sweden who consume denatured alcohol preparations: an analytical-toxicological study.

In the course of analyzing blood samples from drunk drivers, several low molecular weight volatiles were occasionally identified in addition to ethanol on the gas chromatograms. Among 21, 153 blood specimens analyzed during 1986, 77 contained ethanol as well as other volatile agents at the following mean concentrations: ethanol 2090 mg/L (range 830-3410), methanol 49.6 mg/L (range 20-178), acetone 88.3 mg/L (range 12-307), 2-propanol 32.2 mg/L (range 4-99), 2-butanone 49.2 mg/L (range 5-144), and 2-butanol 23.2 mg/L (range 4-64). A technical alcohol widely available in Sweden, trade name T-red, contains 92% w/w ethanol, 2% w/w acetone, and 5% w/w 2-butanone. A red coloring agent and a substance to impart a bitter taste (bitrex) are added to deter consumption. The drinking drivers who consumed technical alcohol were on average older (43 years compared with 35 years) and had higher mean BAC (2090 mg/L compared with 1767 mg/L). Those who drank denatured alcohol were more often apprehended while driving small motorcycles (mopeds) than were control groups of DWI offenders. The use of technical alcohol for intoxication might reflect, at least in part, the high costs and restricted availability of conventional alcoholic beverages in Sweden.

Acetone↗
PubMed1994

Transmission of Borrelia burgdorferi s.l. from mammal reservoirs to the primary vector of Lyme borreliosis, Ixodes ricinus (Acari: Ixodidae), in Sweden.

Factors regulating prevalence of Borrelia burgdorferi s.l. Johnson, Schmid, Hyde, Steigerwalt & Brenner in Ixodes ricinus (L.) were examined during 1991-1992 at Bogesund, near Stockholm in south-central Sweden. Nine species of small and medium-sized mammals (Sorex araneus L., S. minutus L., Neomys fodiens Pennant, Clethrionomys glareolus [Schreber], Microtus agrestis [L.], Apodemus sylvaticus [L.], A. flavicollis [Melchior], Lepus europaeus Pallas, L. timidus L.) were found to infect feeding tick larvae with B. burgdorferi s.l., whereas two species of large mammals (Capreolus capreolus L., Alces alces L.) failed to infect feeding tick larvae with this spirochete. The most important mammalian reservoirs at the study locality were S. araneus and rodents, accounting for 91% of all I. ricinus larvae infected. In view of the great number of potentially effective reservoirs for B. burgdorferi s.l. in Sweden, control of Lyme disease by reduction of abundance of reservoir hosts will be difficult to achieve. We also found that infectivity of a rodent species is related to the number of infesting, potentially infective nymphal I. ricinus. Insectivores and rodents were the most important hosts of larval I. ricinus, whereas most nymphal ticks fed on hares and cervids. Adult I. ricinus were frequently found on all species of hares and cervids examined but never on insectivores and rodents. No single species seemed to be of paramount importance as a source of blood for female ticks. Therefore, control of Lyme disease by reduction of abundance of mammal hosts available for female tick engorgement will probably require massive reductions of numbers of both C. capreolus and L. timidus.

Animals↗
PubMed1998

Increasing geographical distribution and density of Ixodes ricinus (Acari: Ixodidae) in central and northern Sweden.

The geographical distribution and density of Ixodes ricinus (L.) in the 2 northern regions, Svealand and Norrland, in Sweden were studied by using a questionnaire in Swedish magazines for house owners and dog owners, and in provincial newspapers. Analysis of the approximately 1,200 answers revealed that ticks are present in all parts of Svealand (except northern Värmland and northern and western Dalarna), the southeastern part of Norrland (i.e., Gästrikland and Hälsingland), and along the Baltic Sea coast of central and northern Norrland. The proportion of answers reporting ticks and the estimated tick density (i.e., the number of ticks infesting dogs and cats) decreased from south to north. The answers to the questionnaire and data from field sampling of ticks suggest that tick density decreased distinctly along a narrow boundary zone, coinciding with the biological limit of Norrland (Limes Norrlandicus), crossing Sweden through southern Värmland, southeastern Dalarna, and central Gästrikland. The results of the questionnaire suggest that I. ricinus ticks are more widespread today than in the early 1980s, especially in Värmland, western and central Dalarna, Hälsingland, and the coastal areas of Medelpad, Angermanland, and Västerbotten, and that the proportion of the human population at risk for tick-borne pathogens in Svealand and Norrland is increasing.

Animals↗
PubMed1989

Early oral contraceptive use and breast cancer among premenopausal women: final report from a study in southern Sweden.

In southern Sweden during the 1960s, women began to use oral contraceptives (OCs) extensively at a young age. This case-control study investigates the relationship between the use of OCs and breast cancer development in women in southern Sweden diagnosed in the early 1980s. The risk for breast cancer after OC use among premenopausal women was modeled, after adjustment was made for age, age at menarche, and age at first full-term pregnancy or parity. Both the duration of OC use before 25 years of age and commencement of OC use at a young age were associated with a significant increase in the risk of breast cancer as well as a significant trend. The duration of OC use before the first full-term pregnancy was associated with an increased risk of breast cancer, but it did not show a significant trend. The total duration of OC use was weakly, but not significantly, associated with breast cancer development. The odds ratio for women starting OC use before 20 years of age was 5.8 [95% confidence interval (CI), 2.6-12.8]; for women using OCs for greater than 5 years before age 25, it was 5.3 (95% CI, 2.1-13.2); and for women using OCs for greater than or equal to 8 years before first full-term pregnancy, it was 2.0 (95% CI, 0.8-4.7). In multivariate analyses including the different measurements of OC use, only starting age of OC use was significantly associated with breast cancer. The exposure-response relationship between duration of OC use and risk of breast cancer depended on the age at first use of OCs. Given a fixed duration of OC use, the risk increased with younger starting age of OC use. The findings point to the importance of the early reproductive years as risk determinants for breast cancer after OC use.

Adult↗
PubMed2003

Socio-economic status and chronic renal failure: a population-based case-control study in Sweden.

BACKGROUND: Low socio-economic status is associated with the occurrence of several different chronic diseases, but evidence regarding renal disease is scant. To explore whether the risk of chronic renal failure varies by socio-economic status, we performed a population-based case-control study in Sweden. METHODS: All native residents from May 1996 to May 1998, aged 18-74 years, formed the source population. Cases (n = 926) were incident patients with chronic renal failure in a pre-uraemic stage. Control subjects (n = 998) were randomly selected within the source population. Exposures were assessed at personal interviews and relative risks were estimated by odds ratios (OR) in logistic regression models, with adjustment for age, sex, body mass index (BMI), smoking, alcohol consumption and regular analgesics use. RESULTS: In families with unskilled workers only, the risk of chronic renal failure was increased by 110% [OR = 2.1; 95% confidence interval (CI), 1.1-4.0] and 60% (OR = 1.6; 95% CI, 1.0-2.6) among women and men, respectively, relative to subjects living in families in which at least one member was a professional. Subjects with 9 years or less of schooling had a 30% (OR = 1.3; 95% CI, 1.0-1.7) higher risk compared with those with a university education. The excess risk was of similar magnitude regardless of underlying renal disease. CONCLUSIONS: Low socio-economic status is associated with an increased risk of chronic renal failure. The moderate excess was not explained by age, sex, BMI, smoking, alcohol or analgesic intake. Thus, socio-economic status appears to be an independent risk indicator for chronic renal failure in Sweden.

Adolescent↗