Scandinavian Journal of Public Health最新文献

Aims: Compared with the general population, adults in supported housing have an increased risk of poor health and low continuity of healthcare. We explored whether people in supported housing experienced disparities in continuity of general practitioner (GP) care. Further, we explored whether disparities were associated with morbidity, disability, or healthcare utilisation.

Method: This cross-sectional register-based study used nationwide administrative registers and databases to combine unique sociodemographic, health, and healthcare information. A reference population was matched by age, sex and region of residence. Low continuity of care was defined as contact to more than one GP clinic in 2019. Descriptive statistics were conducted.

Results: Among 25,858 people in supported housing in Denmark in 2019, 27.8% had contact with more than one GP clinic in 2019 as compared with 14.1% in the reference population. Supported housing residents who had contact with three or more GP clinics in one year had higher morbidity (27.4% cardiovascular diseases), more GP contacts (mean 15.7 (standard deviation (SD) 8.33)), more contact with out-of-hour medical services (mean 2.87 (SD 4.77)), and more hospital contacts (acute admissions mean 0.88 (SD 2.44)) relative to people with contact with less than three GP clinics.

Conclusions: People in supported housing had a lower continuity of GP care compared with a matched reference population. People in supported housing with low GP continuity had the highest level of morbidity and more frequent contact with both GP and hospital care in one year.

Aims: Global childhood mortality frameworks systematically exclude politically sensitive causes of death, such as genocide. This study quantified child mortality in Gaza during 2024, compared these deaths with established global causes of childhood mortality, and assessed how their omission distorts international health assessments. Methods: We analyzed official Palestinian Ministry of Health (MoH) mortality reports and triangulated them with published capture-recapture studies and indirect-to-direct death ratios (4:1 and 10:1) applied in conflict settings to provide low, medium and high childhood mortality estimates. Annualized deaths among children under 15 years were calculated for 2024 and compared with Global Burden of Disease (GBD) 2021 estimates. Infant and under-five mortality rates were derived using live birth estimates and contrasted with pre-war trends. Results: Official reports cite 60,199 deaths in Gaza as of July 2025; upper sensitivity analysis estimate of total fatalities may reach 601,990 (28% of 2.13 million population). Child deaths (under 15) range from 14,824 (reported) to 59,296 (medium estimate) to 148,240 (high estimate), equating to 2%, 7%, and 17% of the under-15 population, respectively. Under-five mortality likely increased 14-34 times, from 13.9 per 1,000 live births in 2022 to 191.1 (medium) and 477.8 (high) in 2024. Infant mortality potentially increased 4-9 times, from 10.8 to 39.0 and 97.5 per 1,000 live births. For 2024, official reported child deaths rank Gaza 18th globally despite Gaza's being less than 1% of global population; medium and high estimates rank it 15th and 10th, respectively. The estimated 41.74 (med) and 104.36 (high) deaths per 1,000 population position Gaza genocide as the leading cause of child mortality worldwide. Conclusions: Genocide-related child deaths in Gaza represent one of the leading global causes of childhood mortality but remain excluded from international surveillance frameworks. Recognizing and coding genocide as a preventable cause of death is critical for accountability, accurate health metrics, and urgent humanitarian response.

Aims: Youth with an immigrant or refugee background face elevated mental health risks. Schools have been proposed as a suitable setting for mental health interventions for this group, but evidence on effects is limited, and even less is known on dosage impact. Using variations in intervention exposure due to COVID-19 school closures, this study examined the association between the number of modules of the Welcome to School intervention and mental health and resilience outcomes among young immigrant and refugee newcomers.

Methods: In 2019-2020, 11-22-year-old newcomer immigrants and refugees in Denmark, Belgium and Norway were cluster randomised by schools/classes into a control and intervention group. Mental health and resilience outcomes were measured at baseline and following the intervention using the strengths and difficulties questionnaire and the child and youth resilience measure. Due to COVID-19 school closures, the intervention group received different amounts of the 14-modules Welcome to School intervention. Using data from 147 participants, multiple linear regression analyses were performed.

Results: Adjusting for age, gender, resettlement country, and migration reasons, the analyses showed that the emotional symptoms score decreased by 0.19 (95% confidence interval 0.06; 0.32) per Welcome to School module received. No significant dose-response associations were found for resilience scores or the other studied mental health outcomes (i.e. total difficulties, conduct problems, hyperactivity, peer problems, and prosocial behaviour).

Conclusions: The Welcome to School intervention appears to have the potential to reduce emotional difficulties among young newcomers in case of sufficient intervention dose. Further studies are needed to assess the effectiveness of the full intervention.

Aims: This study investigated cross-sectional trends in subjective health complaints (SHCs) over a 10-year period and explored associations between sex, age, normative stress domains, and SHCs. Methods: Data were drawn from three cross-sectional surveys in 2011 (n = 1,289), 2016 (n = 1,233), and 2022 (n =310), including adolescents aged 13-20 from lower- and upper-secondary public schools in rural municipalities in Mid-Norway. SHCs were assessed using a 12-item scale measuring physical and mental symptoms, while stress was measured with the 30-item Adolescent Stress Questionnaire. Descriptive and multiple linear regression analyses were conducted. Results: Average SHC scores were moderately high, showing a slight increase over the study period, and were consistently higher in girls than boys. Age showed a curvilinear association with SHCs, with increasing SHC levels from ages 13 to 16 and declining levels from ages 17 to 20. All stressors associated significantly positively with SHCs controlled for sex and age. Stressors related to the school context were significantly positively associated with SHCs controlled for all covariates, alongside a significant interaction effect of sex by school attendance. Conclusions: The study shows a relatively stable level of SHCs in adolescents, with a minor increase in average levels over the 10 years investigated. Girls reported higher SHCs than boys and a curvilinear association was found between age and SHCs. The findings emphasize the significant influence of especially school-related stressors on adolescent SHCs.

Aims: Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement.

Methods: Individual-level register data were supplemented with 10 municipality-level characteristics from various databases. A 20% sample of the Finnish population (N=626,391) was followed for transition to disability retirement from 2016 to 2019 using multilevel Weibull models.

Results: Of the total variation in the risk of disability retirement, 4.3% was attributed to the municipal-level and decreased to 1.8% when individual-level characteristics (gender, age, education level and entitlement to special reimbursement for medical expenses, reflecting morbidity) were controlled for. Further adjustment for municipality-level characteristics fully erased the differences between municipalities. The proportion of municipality-level variation was larger for disability retirement due to somatic illnesses than mental disorders. Of the municipality-level characteristics, socioeconomic structure, unemployment rate, poverty, net migration between municipalities, dependency ratio, the amount of tax revenue per capita and morbidity were associated with the risk of disability retirement.

Conclusions: The municipality-level variation in the risk of disability retirement is largely explained by the individual characteristics of the inhabitants. However, various characteristics of the municipalities show associations with the risk of disability retirement. Recognizing such factors is essential for shaping policies that mitigate disability retirement risk.

Aims: The decline in old age mortality and subsequent increase in life expectancy among older women has stalled in some high-income countries. The contribution of causes of death to and sub-group variations in these trends are generally not well understood. We assess trends in mortality and cause-of-death decomposition of life expectancy by income over the past 30 years in Finland.

Methods: We obtained total population, annual register-based data on individuals (aged 30-89 years) residing in Finland in 1991-2020. We examined the trends in age-specific mortality rates and decomposed the contribution of various causes of death to changes in partial life expectancy among women aged 65-79 years over time and within each income quintile. In addition, we estimated life expectancy trends for the total population and by income quintile with and without causes related to alcohol consumption and smoking.

Results: Our results indicate stagnation in mortality development among women in Finland aged 65-79 years. The slowdown of improvements in circulatory and heart disease mortality contributed substantially to the observed stagnation, although similar trends were observed in virtually all the causes of death we studied. The lowest income groups experienced the most adverse developments during the study period.

Conclusions: The stagnating life expectancy observed among Finnish women cannot be attributed solely to one cause of death. In contrast to findings on the topic from many other developed countries, smoking-related causes of death were of little significance. The stagnation is linked to growing inequality in mortality development among older women in Finland, which affects the overall trend.

Background: Previous research has shown that the Swedish speaking minority in Finland has slightly but significantly better health compared with the Finnish speaking majority. However, a clear explanation for this is lacking.

Aim: The aim of the study was to explore differences of perceived health comparing three groups: Swedish speakers with reported dominance of Swedish also in the preceding generation; contemporary Finnish speakers with reported dominance of Finnish in the preceding generation and a group with a reported mixed-language structure of Finnish and Swedish between generations.

Individuals and methods: Health and Social Support is an on-going population-based survey initiated in 1998 (N = 64,797), aimed at working-age adults. The present study is based on the 2012 follow-up survey, which included a question on the dominating language (Swedish or Finnish) of the respondents and their parents. The outcome was perceived health, which in this study was dichotomized to very good/good and intermediate/poor/very poor. The statistical analysis was carried with logistic regression, using SAS software. Age, gender and occupational training were included as covariates in the multivariable analysis.

Results: This study found that the Swedish-speaking group in Finland report better perceived health compared with the Finnish-speaking group (odds ratio 1.28, 95% confidence interval 1.04-1.57, p < 0.001). The health of the mixed language-speaking group fell between the other two groups.

Conclusions: The results gave some support to a culturally mediated mechanism for the health advantage of Swedish speakers. Cultural features of Swedish-speaking groups in Finland may also support health promotion of the Finnish-speaking majority.

Aims: We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey.

Methods: We use data from the seventh survey of the population based Tromsø Study (2015-2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics.

Results: Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input.

Conclusions: Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity.

Aim: To describe sociodemographic disparities in temporal trends of incidence and age distributions of first registered osteoarthritis (OA) diagnosis in southern Sweden.

Methods: We identified all Skåne residents aged 35+ who had lived in the region at any point during the period 2006-2019 with no previous OA diagnosis (ICD-10 codes M15-M19) for 8 years prior to inclusion in the study (n = 849,061). We calculated person-years from inclusion until OA diagnosis, death, emigration, or 31 December 2019, whichever occurred first. Combining sex (female, male), education (low, medium, high) and nativity (Swedish, immigrant), we created a variable with 12 strata. Average annual percent changes in age-standardized incidence rates were estimated using joinpoint regression. Changes in the median age-at-diagnosis (year of diagnosis minus birth year), weighted to the mid-2005 Swedish population, were explored.

Results: Cumulative age-standardized incidence rates ranged from 116 (95% CI: 111, 121) per 10,000 person-years for immigrant males with low education to 205 (95% CI: 200, 210) for immigrant females with medium education. The estimated average annual percent changes (ranging from 3.4% to 6.1%) were generally similar, with slightly greater variations among immigrants than Swedes. The weighted median age-at-diagnosis was higher for Swedes and low educated people. Immigrant females with low education were the only stratum with a reduction (3 years) in the weighted median age-at-diagnosis over time. Sociodemographic patterns in knee OA incidence were different from patterns for hip OA.

Conclusions: There were few sociodemographic disparities in temporal trends of OA incidence and age-at-diagnosis, suggesting persistent sociodemographic disparities in OA burden in southern Sweden.

Background: Little is known about associations between occupational prestige, that is, the symbolic evaluation and social positioning of occupations, and sickness absence (SA) or disability pension (DP). We explored whether occupational prestige was associated with future SA or DP among women and men.

Methods: A Swedish 4-year prospective cohort study of all those in paid work and aged 25-59 in 2010 (N = 2,605,227; 47% women), using linked microdata from three nationwide registers and Standard International Occupational Prestige Scale values, categorised as 'very low', 'low', 'medium', 'high', or 'very high'. Odds ratios (ORs), 95% confidence intervals (CIs), crude and adjusted for several sociodemographic factors, were calculated for three outcomes: at least one SA spell (>14 days), >90 SA days, or DP occurrence, during follow-up (2011-2013).

Results: The mean number of SA days in 2010 varied by occupational prestige group, for example, 'very high': 3.0, 'very low': 6.5. Compared to those in occupations with 'very high' prestige, all other groups had higher adjusted ORs for all three outcomes. Among men, those with 'very low' occupational prestige had the highest OR for at least one SA spell: OR 1.51 (95% CI 1.47-1.56); among women, the 'medium' group had the highest OR: 1.30 (1.27-1.32). The results were similar for SA >90 days. OR for DP among women with 'very low' occupational prestige was 2.01 (1.84-2.19), and 3.55 (3.15-4.01) for men.

Conclusions: Working in lower occupational prestige occupations was generally associated with higher odds of future SA/DP than working in higher prestige occupations; these associations were stronger for men than for women.