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Gustafsson, Per E
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Publications (10 of 77) Show all publications
Wagenius, C. M., San Sebastian, M., Gustafsson, P. E. & Goicolea, I. (2018). Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scandinavian Journal of Public Health, Article ID 1403494818774965.
Open this publication in new window or tab >>Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494818774965Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden.

METHODS: The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables.

RESULTS: Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services.

CONCLUSIONS: These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.

Keywords
Inequity, Sweden, access to healthcare, youth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150573 (URN)10.1177/1403494818774965 (DOI)29779450 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-01-08
Jonsson, F., San Sebastian, M., Hammarström, A. & Gustafsson, P. E. (2018). Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis. Health and Place, 52, 127-134
Open this publication in new window or tab >>Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis
2018 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, p. 127-134Article in journal (Refereed) Published
Abstract [en]

This study explains neighbourhood deprivation inequalities in adult health for a northern Swedish cohort by examining the contribution of socio-economic and psychosocial determinants from adolescence (age 16), young adulthood (age 21) and midlife (age 42) to the disparity. Self-reported information from 873 participants was drawn from questionnaires, with complementary neighbourhood register data. The concentration index was used to estimate the inequality while decomposition analyses were run to attribute the disparity to its underlying determinants. The results suggest that socio-economic and psychosocial factors in midlife explain a substantial part, but also that the inequality can originate from conditions in adolescence and young adulthood.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Decomposition analysis, Life course, Neighbourhood inequality, Northern Sweden, Social determinants
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150249 (URN)10.1016/j.healthplace.2018.05.010 (DOI)000439053800014 ()29886129 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451Swedish Research Council Formas, 259-2012-37Västerbotten County Council, 355661Västerbotten County Council, 402131
Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-11-12Bibliographically approved
Mosquera, P. A., San Sebastian, M., Ivarsson, A. & Gustafsson, P. E. (2018). Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population. International Journal for Equity in Health, 17, Article ID 102.
Open this publication in new window or tab >>Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 102Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities.

METHODS: Participants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men.

RESULTS: Health inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = - 0.1850; - 0.1683 and - 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = - 0.1661; - 0.1259 and - 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0-72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders.

CONCLUSION: Taken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.

Keywords
Cardiovascular risk factors, Decomposition analysis, Income inequality, Middle age, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150576 (URN)10.1186/s12939-018-0804-2 (DOI)000438822600001 ()30005665 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451Swedish Research Council, 2008-7491
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-15Bibliographically approved
Ramadani, R. V., Mosquera, P., San Sebastian, M. & Gustafsson, P. E. (2018). The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden. Scandinavian Journal of Public Health, Article ID 1403494818761418.
Open this publication in new window or tab >>The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494818761418Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: This study aimed to investigate the relationship between body mass index (BMI) and health-related quality of life (HRQoL) and whether this relationship is influenced by the level of income in Northern Sweden. Overweight and obesity are rising major public health problems which also affect HRQoL. While socioeconomic inequalities in health are persisting or increasing in many countries, including Sweden, little attention has been paid to the more complex roles of income in relation to health.

METHODS: Data were drawn from a 2014 cross-sectional survey from Northern Sweden (Health on Equal Terms), comprising individuals aged 20-84 years ( N = 20,082 individuals included for analysis). BMI and HRQoL were self-reported and individual disposable income in 2012 was retrieved from population registers. Multiple linear regressions were performed with HRQoL scores regressed on BMI and income, their interaction and additional covariates.

RESULTS: The underweight, overweight and obesity groups reported significantly lower HRQoL compared to the normal weight group. Moreover, the relationship between BMI and HRQoL varied significantly by level of income, with a stronger association among those with the lowest level of income.

CONCLUSIONS: Income has a role as an effect modifier in the relationship between BMI and HRQoL that can be construed as an indirect income inequality. Efforts to promote HRQoL in populations should consider the different impact of being overweight and obese in different socioeconomic groups.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Obesity, Sweden, health-related quality of life, income, inequality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150608 (URN)10.1177/1403494818761418 (DOI)29516787 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014- 2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2019-01-07
Szilcz, M., Mosquera, P. A., Sebastián, M. S. & Gustafsson, P. E. (2018). Time trends in absolute and relative socioeconomic inequalities in leisure time physical inactivity in northern Sweden. Scandinavian Journal of Public Health, 46(1), 112-123
Open this publication in new window or tab >>Time trends in absolute and relative socioeconomic inequalities in leisure time physical inactivity in northern Sweden
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 1, p. 112-123Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim was to investigate the time trends in educational, occupational, and income-related inequalities in leisure time physical inactivity in 2006, 2010, and 2014 in northern Swedish women and men.

METHODS: This study was based on data obtained from the repeated cross-sectional Health on Equal Terms survey of 2006, 2010, and 2014. The analytical sample consisted of 20,667 (2006), 31,787 (2010), and 21,613 (2014) individuals, aged 16-84. Logistic regressions were used to model the probability of physical inactivity given a set of explanatory variables. Slope index of inequality (SII) and relative index of inequality (RII) were used as summary measures of the social gradient in physical inactivity. The linear trend in inequalities and difference between gender and years were estimated by interaction analyses.

RESULTS: The year 2010 displayed the highest physical inactivity inequalities for all socioeconomic position indicators, but educational and occupational inequalities decreased in 2014. However, significant positive linear trends were found in absolute and relative income inequalities. Moreover, women had significantly higher RII of education in physical inactivity in 2014 and significantly higher SII and RII of income in physical inactivity in 2010, than did men in the same years.

CONCLUSIONS: The recent reduction in educational and occupational inequalities following the high inequalities around the time of the great recession in 2010 suggests that the current policies might be fairly effective. However, to eventually alleviate inequities in physical inactivity, the focus of the researchers and policymakers should be directed toward the widening trends of income inequalities in physical inactivity.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Physical inactivity, relative index of inequality, slope index of inequality, socioeconomic inequality, time trend
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143318 (URN)10.1177/1403494817713123 (DOI)000428758000016 ()28707564 (PubMedID)
Note

Special Issue

Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Boldis, B. V., San Sebastian, M. & Gustafsson, P. E. (2018). Unsafe and unequal: a decomposition analysis of income inequalities in fear of crime in northern Sweden. International Journal for Equity in Health, 17, Article ID 110.
Open this publication in new window or tab >>Unsafe and unequal: a decomposition analysis of income inequalities in fear of crime in northern Sweden
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 110Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Fear of crime is not solely an individual concern, but as a social determinant of health structured by gender it also poses a threat to public health. Social inequalities are thought to represent a breeding ground for fear of crime, which subsequently may contribute to social inequalities in health. However, little research has focused on social inequalities in fear of crime, particularly in Sweden where the level of fear of crime and income and gender inequalities are comparatively low. With a conceptual model as a point of departure, the present study aimed to estimate and decompose income-related inequalities and explore gender differences in fear of crime in northern Sweden.

METHODS: Participants (N = 22,140; 10,220 men and 11,920 women aged 16 to 84 years) came from the Health on Equal Terms cross-sectional survey with linked register data, carried out in the four northernmost counties of Sweden in 2014. Disposable income was used as the socio-economic indicator, fear of crime as the binary outcome variable, and sociodemographic characteristics, residential context, socio-economic and material conditions and psychosocial conditions as explanatory factors. Concentration curve and concentration index were used to estimate the income inequality in fear of crime, and decomposition analysis to identify the key determinants of the inequalities, in collapsed and gender-stratified analyses.

RESULTS: Substantial gender differences were found in the prevalence of fear of crime (20.8% in women and 3.5% and men) and among the contributing factors to fear of crime. Additionally, the analyses revealed considerable income inequalities in fear of crime in the northern Swedish context (C = - 0.219). Gender, socio-economic and material, and psychosocial conditions explained the most in income inequalities of fear of crime in the total population.

CONCLUSIONS: The existing gender and socio-economic inequities need to be approached as a greater structural problem to mitigate inequalities in fear of crime. Further research is needed to reveal more aspects of income inequalities in fear of crime and to develop efforts to create safe environments for all.

Keywords
Concentration index, Decomposition analysis, Fear of crime, Gender, Income inequality, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:umu:diva-150575 (URN)10.1186/s12939-018-0823-z (DOI)000440468000001 ()30068322 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–0451
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-09-04Bibliographically approved
San Sebastian, M., Mosquera, P. & Gustafsson, P. E. (2018). Whose income is more important: mine, yours or ours? Income inequality and mental health in northern Sweden. European Journal of Public Health, 28(6), 1056-1061
Open this publication in new window or tab >>Whose income is more important: mine, yours or ours? Income inequality and mental health in northern Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1056-1061Article in journal (Refereed) Published
Abstract [en]

Background: Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden.

Methods: Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25-84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses.

Results: A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2-3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76).

Conclusion: This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150577 (URN)10.1093/eurpub/cky110 (DOI)29982407 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014- 0451Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00236
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-01-08Bibliographically approved
Córdoba-Doña, J. A., Escolar-Pujolar, A., San Sebastián, M. & Gustafsson, P. E. (2018). Withstanding austerity: equity in health services utilisation in the first stage of the economic recession in Southern Spain. PLoS ONE, 13(3), Article ID e0195293.
Open this publication in new window or tab >>Withstanding austerity: equity in health services utilisation in the first stage of the economic recession in Southern Spain
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 3, article id e0195293Article in journal (Refereed) Published
Abstract [en]

Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011-2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socioeconomic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-130574 (URN)10.1371/journal.pone.0195293 (DOI)000428845900026 ()29601609 (PubMedID)2-s2.0-85044858050 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1512; 2014-0451
Note

Originally included in thesis in manuscript form with title: Withstanding austerity: equity in access to health services in the first stage of the economic recession in southern Spain

Available from: 2017-01-24 Created: 2017-01-24 Last updated: 2018-06-25Bibliographically approved
Mosquera, P. A., San Sebastian, M., Ivarsson, A., Weinehall, L. & Gustafsson, P. E. (2017). Are health inequalities rooted in the past? Income inequalities in metabolic syndrome decomposed by childhood conditions. European Journal of Public Health, 27(2), 223-233
Open this publication in new window or tab >>Are health inequalities rooted in the past? Income inequalities in metabolic syndrome decomposed by childhood conditions
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2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 223-233Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood.

METHODS: The sample (N = 12 481) comprised all 40- and 50-year-old participants in the Västerbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40-50 years, as well as childhood conditions at participant age 10-12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis.

RESULTS: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions.

CONCLUSIONS: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come.

Keywords
Metabolic syndrome, Early-life conditions, Income inequality, Decomposition analysis, Life course
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-126888 (URN)10.1093/eurpub/ckw186 (DOI)000398086400009 ()27744345 (PubMedID)
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2018-06-09Bibliographically approved
Brydsten, A., Gustafsson, P. E., Hammarström, A. & San Sebastian, M. (2017). Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms. Health and Place, 43, 113-120
Open this publication in new window or tab >>Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms
2017 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 43, p. 113-120Article in journal (Refereed) Published
Abstract [en]

This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131334 (URN)10.1016/j.healthplace.2016.11.014 (DOI)000394402400014 ()27997864 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2018-06-09Bibliographically approved
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