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Karhina, K., Ng, N., Ghazinour, M. & Eriksson, M. (2016). Gender differences in the association between cognitive social capital, self-rated health, and depressive symptoms: a comparative analysis of Sweden and Ukraine. International Journal of Mental Health Systems, 10, Article ID 37.
Open this publication in new window or tab >>Gender differences in the association between cognitive social capital, self-rated health, and depressive symptoms: a comparative analysis of Sweden and Ukraine
2016 (English)In: International Journal of Mental Health Systems, ISSN 1752-4458, E-ISSN 1752-4458, Vol. 10, 37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Social capital is one of the social determinants of health, but there is still a lack of studies comparing its significance for health in different cultural settings. This study investigates and compares the relations between individual cognitive social capital and depressive symptoms and self-rated health in Sweden and Ukraine for men and women separately.

STUDY DESIGN: Two cross-sectional nationally representative surveys of adult populations were used for the analysis. Data from the Ukraine's World Health Survey and the Sweden's National Public Health Survey were analyzed in this comparative study.

METHODS: The independent variable, cognitive social capital, was operationalized as institutional trust and feelings of safety. Depressive symptoms and self-rated health were used as the outcome variables. Crude and adjusted odds ratios and the 95 % confidence intervals were calculated using logistic regression. The model also adjusted for socio-demographic and lifestyle variables.

RESULTS: Institutional trust is higher in Sweden compared to Ukraine (31 % of the Swedes vs. 12 % of the Ukrainians reported high trust to their national government/parliament). There is a strong association between self-rated health and institutional trust for both sexes in Sweden (odds ratio/OR = 1.99; 95 % CI = 1.58-2.50 for women and OR = 1.82, CI = 1.48-2.24 for men who reported low institutional trust compared with those with high institutional trust) but only for women (OR = 1.88, CI = 1.12-3.15) in Ukraine. Trust thus seems to be more important for self-rated health of women and men in Sweden compared to their counterparts in Ukraine. Significant associations between depressive symptoms and institutional trust were not observed in either country after adjusting for socio-demographic and lifestyle factors. A lack of feeling of safety increased the odds of having depressive symptoms among women (OR = 1.97, CI = 1.41-2.76) and men (OR = 3.91, CI = 2.19-6.97) in Sweden. The same association was observed for poor self-rated health among Swedish women (OR = 2.15, CI = 1.55-2.99) and men (OR = 2.75, CI = 1.58-4.80). In Ukraine, a lack of feeling of safety did not show any significant association with self-rated health or depressive symptoms for men, but it increased the odds of depressive symptoms among women (OR = 1.72, CI = 1.13-2.62).

CONCLUSIONS: In general, individual cognitive social capital is higher in Sweden than in Ukraine, and there is a stronger association between cognitive social capital and self-rated health in Sweden than in Ukraine. Interventions aiming to increase cognitive social capital for health promoting purposes might be favorable in Sweden, but this is not evidently the case in Ukraine.

Keyword
Social capital, Trust, Safety, Self-rated health, Depressive symptoms, Sweden, Ukraine
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-121918 (URN)10.1186/s13033-016-0068-4 (DOI)000376368700001 ()27148401 (PubMedID)
Available from: 2016-06-10 Created: 2016-06-10 Last updated: 2017-11-28Bibliographically approved
Vaezghasemi, M., Ng, N., Eriksson, M. & Subramanian, S. V. (2016). Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia. International Journal for Equity in Health, 15, Article ID 102.
Open this publication in new window or tab >>Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia
2016 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, 102Article in journal (Refereed) Published
Abstract [en]

Background: Most of the research investigating the effect of social context on individual health outcomes has interpreted context in terms of the residential environment. In these studies, individuals are nested within their neighbourhoods or communities, disregarding the intermediate household level that lies between individuals and their residential environment. Households are an important determinant of health yet they are rarely included at the contextual level in research examining association between body mass index (BMI) and the social determinants of health. In this study, our main aim was to provide a methodological demonstration of multilevel analysis, which disentangles the simultaneous effects of households and districts as well as their associated predictors on BMI over time.

Methods: Using both two- and three-level multilevel analysis, we utilized data from all four cross-sections of the Indonesian Family life Survey (IFLS) 1993 to 2007-8.

Results: We found that: (i) the variation in BMI attributable to districts decreased from 4.3 % in 1993 to 1.5 % in 1997-98, and remained constant until 2007-08, while there was an alarming increase in the variation of BMI attributable to households, from 10 % in 2000 to 15 % in 2007-08; (ii) ignoring the household level did not change the relative variance contribution of districts on BMI, but ignoring the district level resulted in overestimation of household effects, and (iii) households' characteristics (socioeconomic status, size, and place of residence) did not attenuate the variation of BMI at the household-level.

Conclusions: Estimating the relative importance of multiple social settings allows us to better understand and unpack the variation in clustered or hieratical data in order to make valid and robust inferences. Our findings will help direct investment of limited public health resources to the appropriate context in order to reduce health risk (variation in BMI) and promote population health.

Keyword
Body mass index, Multilevel modelling, Omitted level, Contextual effect, Households, Indonesian family life survey
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-124508 (URN)10.1186/s12939-016-0388-7 (DOI)000380105800001 ()27388459 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-15 Last updated: 2017-11-28Bibliographically approved
Santosa, A., Schröders, J., Vaezghasemi, M. & Ng, N. (2016). Inequality in disability-free life expectancies among older men and women in six countries with developing economies. Journal of Epidemiology and Community Health, 70(9), 855-861.
Open this publication in new window or tab >>Inequality in disability-free life expectancies among older men and women in six countries with developing economies
2016 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, 855-861 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

METHODS: This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007-2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

RESULTS: The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

CONCLUSIONS: There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

Keyword
Health expectancy, population ageing, disability, health inequality, low-and middle-income countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118872 (URN)10.1136/jech-2015-206640 (DOI)000383291100003 ()26994068 (PubMedID)
Funder
Swedish Research Council, Dnr: 2013-2056
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-11-30Bibliographically approved
Nichter, M., Padmawati, S. & Ng, N. (2016). Introducing smoking cessation to Indonesian males treated for tuberculosis: The challenges of low-moderate level smoking. Social Science and Medicine, 152, 70-79.
Open this publication in new window or tab >>Introducing smoking cessation to Indonesian males treated for tuberculosis: The challenges of low-moderate level smoking
2016 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 152, 70-79 p.Article in journal (Refereed) Published
Abstract [en]

There is a dearth of information about the smoking habits of people currently and formerly treated for tuberculosis (TB) in low- and middle-income countries (LMICs). In this paper we describe research carried out in Indonesia between 2007 and 2011 designed to investigate both the impact of TB-specific quit smoking messages in the TB clinic and at home, and shifts in patterns of smoking among those formerly treated for TB who continue to smoke. The results of a modest two-arm smoking cessation trial involving 87 patients undergoing Directly Observed Therapy Short course treatment (DOTS) for TB are presented. In one arm patients received a TB-specific quit smoking message delivered by doctors and a TB and smoking educational booklet and quit smoking guide. In the second, family support arm, patients also received on-going cessation messages delivered by family members trained to be DOTS supporters. The study followed patients twice during their six months of DOTS treatment and twice six months post treatment. Both arms of the study reduced rates of smoking during and following TB treatment significantly with 73% of patients in the doctor arm and 71% in the family support arm remaining quit at the end of the treatment (month 6). When complete abstinence at six months after treatment was taken as a primary outcome measure, no statistical difference was found in the effectiveness of the two arms of the intervention. Notably, 67% of higher-level smokers at baseline and 33% of low-moderate level smokers at baseline quit entirely. Many of those who resumed smoking did so at low-moderate levels (<6 cigarettes a day). Eighty-four percent of patients who quit during treatment maintained their abstinence six months after treatment, 13% resumed smoking at a low-moderate level (<6 cigarettes), and only 3% resumed smoking at a higher level. A purposeful sample of 15 patients who shifted from heavy smoking (20-40 cigarettes per day) to low-moderate levels of smoking post treatment were followed for an additional 12 months. We report on their ability to sustain lower levels of smoking and self-perceived smoking status given their dramatic reduction in cigarette consumption. This is the first study of low-moderate level smoking among patients formerly treated for TB conducted anywhere in South-East Asia.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-117302 (URN)10.1016/j.socscimed.2016.01.028 (DOI)000371836700009 ()26845463 (PubMedID)
Available from: 2016-02-26 Created: 2016-02-26 Last updated: 2017-11-30Bibliographically approved
Gangane, N., Anshu, A., Manvatkar, S., Ng, N., Hurtig, A.-K. & San Sebastián, M. (2016). Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India. Asia-Pacific journal of public health, 28(1), 72-82.
Open this publication in new window or tab >>Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India
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2016 (English)In: Asia-Pacific journal of public health, ISSN 1941-2479, Vol. 28, no 1, 72-82 p.Article in journal (Refereed) Published
Abstract [en]

Delay in seeking health care by women with breast cancer increases mortality risk. This study was conducted in rural India to identify risk factors associated with patient delay. A total of 212 women with primary breast cancer diagnosed between 2010 and 2012 were interviewed. Sociodemographic characteristics, time interval between seeking medical attention and appearance of symptoms, and reasons for delay were inquired. Patient delay was defined as more than 3 months between date of first symptoms and medical consultation. Logistic regression was applied to assess associations between potential risk factors and patient delay. Almost half the women with breast cancer experienced patient delay. Age more than 60 years (odds ratio = 4.9, 95% confidence interval = 1.3-18.0) was significantly associated with patient delay. Only 6.6% of patients had heard about breast self-examination. Significantly higher number of patients with delay presented with advanced clinical stage (P = .000). Health education programs should be introduced with specific strategies to shorten patient delay.

Keyword
breast cancer, patient delay, screening, rural India
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-112841 (URN)10.1177/1010539515620630 (DOI)000368770300008 ()26658324 (PubMedID)
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2016-02-24Bibliographically approved
Eriksson, M. & Ng, N. (2015). Changes in access to structural social capital and its influence on self-rated health over time for middle-aged men and women: a longitudinal study from northern Sweden.. Social Science and Medicine, 130, 250-258.
Open this publication in new window or tab >>Changes in access to structural social capital and its influence on self-rated health over time for middle-aged men and women: a longitudinal study from northern Sweden.
2015 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 130, 250-258 p.Article in journal (Refereed) Published
Abstract [en]

Until recently, most studies on social capital and health have been cross-sectional making it difficult to draw causal conclusions. This longitudinal study used data from 33,621 individuals (15,822 men and 17,799 women) from the Vasterbotten Intervention Program, to analyse how changes in access to individual social capital influence self-rated health (SRH) over time. Two forms of structural social capital, i.e. informal socializing and social participation, were measured. Age, sex, education, marital status, smoking, snuff, physical activity, alcohol consumption, high blood pressure, and body mass index were analysed as potential confounders. The association between changes in access to structural social capital and SRH in the follow-up was adjusted for SRH at baseline, as well as for changes in the socio-demographic and health-risk variables over time. The results support that changes in access to structural social capital over time impact on SRH. Remaining with no/low level of informal socializing over time increased the odds ratio for poor SRH for both men and women (OR of 1.45; 95%CI = 1.22-1.73 among men and OR of 1.56; 95%CI = 1.33-1.84 among women). Remaining with no/low levels of social participation was also detrimental to SRH in men and women (OR 1.14; 95%CI = 1.03-1.26 among men and OR 1.18; 95% Cl = 1.08-1.29 among women). A decrease in informal socializing over time was associated with poor SRH for women and men (OR of 135; 95%CI = 1.16-1.58 among men and OR of 1.57; 95%Cl = 1.36-1.82 among women). A loss of social participation had a negative effect on SRH among men and women (OR of 1.16; 95%Cl = 1.03-130 among men and OR of 1.15; 95%CI = 1.04-1.27 among women). Gaining access to social participation was harmful for SRH for women (OR 1.17; 95%CI = 1.05-131). Structural social capital has complex and gendered effects on SRH and interventions aiming to use social capital for health promotion purposes require an awareness of its gendered nature.

Keyword
Northern Sweden,  Social capital,  Self-rated health,  Longitudinal study,  Vasterbotten Intervention Program,  Gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-101056 (URN)10.1016/j.socscimed.2015.02.029 (DOI)000351785500028 ()25734610 (PubMedID)
Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2017-05-23Bibliographically approved
Wu, F., Guo, Y., Chatterji, S., Zheng, Y., Naidoo, N., Jiang, Y., . . . Kowal, P. (2015). Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1. BMC Public Health, 15, Article ID 88.
Open this publication in new window or tab >>Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1
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2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 88Article in journal (Refereed) Published
Abstract [en]

Background: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- and upper-middle income countries. Methods: The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors. Results: The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa. Conclusion: There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

Keyword
Chronic non-communicable diseases, SAGE, Tobacco use, Obesity, Low- and middle-income countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-102290 (URN)10.1186/s12889-015-1407-0 (DOI)000349745200001 ()25885218 (PubMedID)
Available from: 2015-06-24 Created: 2015-04-23 Last updated: 2017-12-04Bibliographically approved
Wilunda, B., Ng, N. & Stewart Williams, J. (2015). Health and ageing in Nairobi's informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study. BMC Public Health, 15, Article ID 1231.
Open this publication in new window or tab >>Health and ageing in Nairobi's informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 1231Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Much of the focus on population ageing has been in high-income counties. Relatively less attention is given to the world's poorest region, Sub-Saharan Africa (SSA) where children and adolescents still comprise a high proportion of the population. Yet the number of adults aged 60-plus in SSA is already twice that in northern Europe. In addition, SSA is experiencing massive rural to urban migration with consequent expansion of informal urban settlements, or slums, whose health problems are usually unrecognised and not addressed. This study aims to improve understanding of functional health and well-being in older adult slum-dwellers in Nairobi (Kenya).

METHODS: The study sample comprised men and women, aged 50 years and over, living in Korogocho and Viwandani, Nairobi, Kenya (n = 1,878). Data from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) and the WHO Study on global AGEing and adult health (SAGE Wave 1) were analysed. The prevalence of poor self-reported quality of life (QoL) and difficulties in domain-specific function is estimated by age and sex. Logistic regression investigates associations between difficulties in the domains of function and poor QoL, adjusting for age, sex and socio-demographic factors. Statistical significance is set at P<0.05.

RESULTS: Women reported poorer QoL and greater functional difficulties than men in all domains except self-care. In the multivariable logistic regression the odds of poor QoL among respondents with problems or difficulties in relation to affect (OR = 7.0; 95%CI = 3.0-16.0), pain/discomfort (OR = 3.6; 95%CI = 2.3-5.8), cognition (OR = 1.8; 95 %CI = 1.2-2.9) and mobility (OR = 1.8; 95%CI = 1.1-2.8) were statistically significant.

CONCLUSIONS: The findings underscore differences in the domains of functional health that encapsulate women and men's capacities to perform regular activities and the impact of poor functioning on QoL. Investing in the health and QoL of older people in SSA will be crucial in helping the region to realise key development goals and in opening opportunities for improved health outcomes and sustainable economic development.

Keyword
Functional health, Domains of health, Quality of life, Informal settlements, Slums, Ageing, Aging, Nairobi, Kenya, Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-112840 (URN)10.1186/s12889-015-2556-x (DOI)000366103500001 ()26652252 (PubMedID)
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2017-12-01Bibliographically approved
Schröders, J., Wall, S., Kusnanto, H. & Ng, N. (2015). Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature. PLoS ONE, 10(5), Article ID e0123629.
Open this publication in new window or tab >>Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, e0123629Article, review/survey (Refereed) Published
Abstract [en]

Introduction Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

Methods and Findings We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable "disadvantaged populations" was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

Conclusion This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-106275 (URN)10.1371/journal.pone.0123629 (DOI)000353943400006 ()25942491 (PubMedID)
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2017-12-04Bibliographically approved
Ng, N., Sandberg, M. & Ahlström, G. (2015). Prevalence of older people with intellectual disability in Sweden: a spatial epidemiological analysis.. Journal of Intellectual Disability Research, 59(12), 1155-1167.
Open this publication in new window or tab >>Prevalence of older people with intellectual disability in Sweden: a spatial epidemiological analysis.
2015 (English)In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 59, no 12, 1155-1167 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The expected increase in longevity of individuals with intellectual disabilities (ID) in many countries of the world is a direct result of medical and social advances, which have also extended the longevity of the general population. It is important to assess the need for social services for people with ID across different administrative levels to ensure sufficient resources are allocated to where they are most needed. This study estimates the annual prevalence of older people with ID from 2004 to 2012 and in different counties and municipalities in Sweden, by sex and age group; identifies proxy indicators related to the care of older people with ID in different counties in 2012 in Sweden and analyses the spatial distribution and clustering of municipalities with a high prevalence of older people with ID.

METHODS: Individuals with ID were identified through the national register based on the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS act) and the national death register. This study focuses on older individuals aged 55+ during the period of 2004-2012. The estimated prevalence was calculated at the county and municipality level and plotted on a municipality-level map. Moran's I statistics was used to identify any spatial clustering of municipalities with a large number of individuals with ID.

RESULTS: The prevalence of ID among older individuals aged 55+ in Sweden increased from 2004 to 2012. The prevalence was consistently higher among men, and the gender gap increased slightly in recent years. Age-specific prevalence estimates showed ID to be higher in younger age groups, and the gender gap decreased in older age groups. The prevalence was higher in northern counties in Sweden (over 500 individuals per 100 000 population aged 55+). Higher prevalence areas were clustered in northern municipalities, whereas municipalities with high prevalence of older individuals with ID in the middle and southern regions of Sweden demonstrated a more widespread distribution.

CONCLUSIONS: The existence of clusters of counties with a high prevalence of older individuals with ID necessitates further assessment of how resources have been allocated to different counties and municipalities in Sweden. Investigations of the quality of social services provided to individuals with ID across different counties in Sweden are warranted. It is important to ensure that high quality supports are being provided to older individuals with ID in order to grant them the same right to healthy ageing as their counterparts living without ID throughout their life course.

Keyword
clustering, developmental disorder, healthy ageing, intellectual disability, learningdisability, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110446 (URN)10.1111/jir.12219 (DOI)000368289500007 ()26306552 (PubMedID)
Available from: 2015-10-21 Created: 2015-10-21 Last updated: 2017-05-30Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-0556-1483

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