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Gustafsson, Per E
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Publications (10 of 88) Show all publications
Vaezghasemi, M., Mosquera, P., Gustafsson, P. E., Nilsson, K. & Strandh, M. (2020). Decomposition of income-related inequality in upper secondary school completion in Sweden by mental health, family conditions and contextual characteristics.. SSM - Population Health, 11, 1-8, Article ID 100566.
Open this publication in new window or tab >>Decomposition of income-related inequality in upper secondary school completion in Sweden by mental health, family conditions and contextual characteristics.
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2020 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 11, p. 1-8, article id 100566Article in journal (Refereed) Published
Abstract [en]

Background: While previous research has evidently and extensively acknowledged socioeconomic gradients in children's education, we know very little about the determinants of socioeconomic-related inequality in children's education at the population level in Sweden. Therefore, we aimed: (i) to assess the extent of income inequality in upper secondary school completion in Sweden; (ii) to examine the contribution of mental health and other determinants to income inequality; and (iii) to explore gender differences in the magnitude and determinants of the inequalities.

Method: We utilised data from a population-based cohort available in Umeå SIMSAM Lab, linked with several national registries in Sweden. The dataset includes all children who were born in Sweden in 1991 and completed or not completed their upper secondary education in 2010, n = 116,812 (56,612 girls and 60,200 boys). We analysed the data using a Wagstaff-type decomposition method.

Results: The results first show substantial income-related inequality in upper secondary school incompletion concentrated among the poor in the Swedish setting. Second, these inequalities were in turn to a large degree explained jointly by parental, family and child factors; primarily parents' income and education, number of siblings and child's poor mental health. Third, these inferences remained when boys and girls were considered separately, although the determinants explained a greater share of the inequalities in boys than in girls.

Conclusion: Our results highlighted substantial income-related inequality in upper secondary school incompletion concentrated among the poor in the Swedish setting. Apart from family level characteristics, which explained a large portion of the inequalities, mental health problems appeared to be of particular importance as they represent a central target for both increasing the population average in upper secondary school completion and for reducing the gap in income-related inequalities in Sweden.

Keywords
Decomposition analysis, Income inequality, Mental health, School achievement, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-170063 (URN)10.1016/j.ssmph.2020.100566 (DOI)32258354 (PubMedID)
Available from: 2020-04-24 Created: 2020-04-24 Last updated: 2020-05-04Bibliographically approved
Amroussia, N., Gustafsson, P. E. & Pearson, J. L. (2020). Do inequalities add up?: Intersectional inequalities in smoking by sexual orientation and education among U.S. adults. Preventive Medicine Reports, 17, Article ID 101032.
Open this publication in new window or tab >>Do inequalities add up?: Intersectional inequalities in smoking by sexual orientation and education among U.S. adults
2020 (English)In: Preventive Medicine Reports, ISSN 0350-1159, E-ISSN 2211-3355, Vol. 17, article id 101032Article in journal (Refereed) Published
Abstract [en]

Introduction: Inequalities in smoking by socio-economic status (SES) are well-known. A growing body of literature has demonstrated additional inequalities in smoking by sexual orientation. This study used an intersectional lens to examine smoking at the intersection of sexual orientation and education.

Methods: Data come from 28,362 adult participants in Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. We used educational level (less than high school education (HS); HS or more) and sexual orientation (heterosexual; sexual minority) to form four intersectional positions.

We estimated prevalence differences in smoking corresponding to joint, referent, and excess intersectional inequalities using weighted linear binomial regression models. Results were stratified by gender and adjusted for ethnicity and age.

Results: The adjusted joint inequality represented 7.6% points (p.p.) (95% CI: 2.5, 12.8) difference in smoking between the doubly advantaged (heterosexual with HS or more) and doubly disadvantaged (sexual minority with less than HS) positions. Joint inequality was decomposed into referent SES inequality (12.5 p.p. (95% CI: 10.5, 14.4)); referent sexual orientation inequality (9.7 p.p. (95% CI: 6.8, 12.6)); and a substantial negative excess intersectional inequality (−14.6 p.p. (95% CI: −20.8, −8.3)), attributed to an unexpectedly low prevalence of smoking among doubly disadvantaged persons. Similar overall patterns were found in the stratified analyses.

Conclusions: We found that “doubly-disadvantaged” group of low-educated sexual minority adults did not have the greatest burden of smoking; whereas, low-educated heterosexual adults had the highest smoking prevalence. Our findings support tailoring cessation interventions to disadvantaged groups’ different needs.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Cigarette smoking, Health inequality, Intersectionality, Sexual and Gender minorities, Socio-economic status, United States
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-171190 (URN)10.1016/j.pmedr.2019.101032 (DOI)31956472 (PubMedID)2-s2.0-85077505580 (Scopus ID)
Available from: 2020-05-28 Created: 2020-05-28 Last updated: 2020-06-01Bibliographically approved
Wagenius, C. M., San Sebastian, M., Gustafsson, P. E. & Goicolea, I. (2019). Access for all?: Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scandinavian Journal of Public Health, 47
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
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47Article in journal (Refereed) Published
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)000458888900001 ()29779450 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-04-16Bibliographically approved
San Sebastian, M., Mosquera, P. A. & Gustafsson, P. E. (2019). Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis. BMC Public Health, 19, Article ID 202.
Open this publication in new window or tab >>Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 202Article in journal (Refereed) Published
Abstract [en]

Background: Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987-2013.

Methods: An ecological controlled interrupted time series design, with pre-intervention period defined as 1987-1993 and post-intervention period 1994-2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.

Results: Impressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.

Conclusions: Taken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Ischemic heart disease, Morbidity, Mortality, Interrupted time series analysis, Intervention, Northern Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157210 (URN)10.1186/s12889-019-6514-x (DOI)000459132800003 ()30770750 (PubMedID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Szilcz, M., Mosquera, P., San Sebastian, M. & Gustafsson, P. E. (2019). Income inequalities in leisure time physical inactivity in northern Sweden: a decomposition analysis. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Income inequalities in leisure time physical inactivity in northern Sweden: a decomposition analysis
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Increasing income inequalities in leisure time physical inactivity have been reported in the relatively socially equal setting of northern Sweden. The present report seeks to contribute to the literature by exploring the contribution of different factors to the income inequalities in leisure time physical inactivity in northern Sweden.

METHODS: This study was based on the 2014 Health on Equal Terms survey, distributed in the four northernmost counties of Sweden. The analytical sample consisted of 21,000 respondents aged 16-84. Six thematic groups of explanatory variables were used: demographic variables, socioeconomic factors, material resources, family-, psychosocial conditions and functional limitations. Income inequalities in leisure time physical inactivity were decomposed by Wagstaff-type decomposition analysis.

RESULTS: Income inequalities in leisure time physical inactivity were found to be explained to a considerable degree by health-related limitations and unfavourable socioeconomic conditions. Material and psychosocial conditions seemed to be of moderate importance, whereas family and demographic characteristics were of minor importance.

CONCLUSIONS: This study suggests that in order to achieve an economically equal leisure time physical inactivity, policy may need to target the two main barriers of functional limitations and socioeconomic disadvantages.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Decomposition analysis, income, inequalities, leisure time physical inactivity, northern Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-158197 (URN)10.1177/1403494818812647 (DOI)30632908 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-08-15
Fritzell, S., Källberg, H., Busch, H. & Gustafsson, P. E. (2019). Income-related inequalities in mental health in Sweden and the role of social determinants. Paper presented at 12th European Public Health Conference, Building bridges for solidarity and public health, Marseille, France 20th–23rd November 2019. European Journal of Public Health, 29(Suppl 4), 233-233
Open this publication in new window or tab >>Income-related inequalities in mental health in Sweden and the role of social determinants
2019 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no Suppl 4, p. 233-233Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Mental health is an increasing concern in all European countries as the burden of mental disorders continue to grow and cause substantial suffering and costs to societies. Furthermore, research shows there are social inequalities in the distribution of mental illness. This study aims to increase knowledge on income-related inequalities in mental health in Sweden and the role of social determinants.

Methods: Drawing on a national survey (Health on Equal Terms) representative of the population aged 16-84, years 2010-2015 (n = 57107) we quantify the income-related inequality in mental health and estimate the contribution of social determinants of the inequality. Poor mental health is defined as a value of at least 3, based on the general health questionnaire (GHQ)-12. Income is measured as yearly disposable income. Income related inequalities in mental health are quantified by the concentration index and decomposed using the Wagstaff-type decomposition analysis.

Results: Preliminary results show that the income inequalities in mental health, as measured by the overall concentration index in mental health was - 0,16 (95% CI -0.17 to -0.15), indicating income inequalities to the disadvantage of those less affluent. The determinants that contributed most to the inequalities were employment, financial strain and experiencing harassment. Together they explained 43 % of the income inequalities in mental health. Generally, socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.

Conclusions: The income related inequalities in mental health are substantial in Sweden. Recently, a national target of reducing the preventable inequalities in health within a generation was adopted. To improve surveillance of inequalities and inform policy we need to closely follow the development of inequalities in mental health and to disentangle the contribution of specific social determinants.

Key messages

  • Income-related inequalities in mental health in Sweden are considerable.

  • Socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-167602 (URN)10.1093/eurpub/ckz185.633 (DOI)000506895302019 ()
Conference
12th European Public Health Conference, Building bridges for solidarity and public health, Marseille, France 20th–23rd November 2019
Available from: 2020-03-02 Created: 2020-03-02 Last updated: 2020-03-02Bibliographically approved
Trygg, N., Gustafsson, P. E. & Månsdotter, A. (2019). Languishing in the crossroad?: A scoping review of intersectional inequalities in mental health. International Journal for Equity in Health, 18, Article ID 115.
Open this publication in new window or tab >>Languishing in the crossroad?: A scoping review of intersectional inequalities in mental health
2019 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, article id 115Article, review/survey (Refereed) Published
Abstract [en]

The concept of intersectionality has gradually been introduced to health inequality research, adding depth and breadth to the way inequalities in health are approached. We conducted a scoping review with the purpose to systematically map, describe and analyze the literature about intersectional inequalities in mental health. For eligibility, the study had to analyze and report inequality defined by combinations of socioeconomic position, gender, race/ethnicity, sexual orientation or religion. The mental health outcome had to be measured as self-reported symptoms assessed through validated scales, or disorders assessed through diagnostic interviews. The search strategy was applied in two databases and the screening process yielded 20 studies. The interaction of intersectional positions showed no consistent patterns in mental health across studies, but both synergistic and antagonistic effects were observed. In most studies an absolute measure of inequality was used and few studies analyzed factors potentially explaining the intersectional inequalities. Taken together, the findings of this review highlight the value of assessing intersectional inequalities across population groups for priority setting and action on mental health inequalities.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Intersectionality, Methods, Health inequalities, Mental health and disorders
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-161989 (URN)10.1186/s12939-019-1012-4 (DOI)000477013200002 ()31340832 (PubMedID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved
Ramadani, R. V., Mosquera, P. A., San Sebastián, M. & Gustafsson, P. E. (2019). 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, 47(7), 765-773
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
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 7, p. 765-773Article in journal (Refereed) Published
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, 2019
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)000503081200011 ()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: 2020-01-09Bibliographically approved
Waenerlund, A.-K., Mosquera, P., Gustafsson, P. E. & San Sebastian, M. (2019). Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–2010. Scandinavian Journal of Public Health, 47, Article ID 1403494818790406.
Open this publication in new window or tab >>Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–2010
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, article id 1403494818790406Article in journal (Refereed) Published
Abstract [en]

AIMS: Research is scarce regarding studies on income and educational inequality trends in cardiovascular disease in Sweden. The aim of this study was to assess trends in educational and income inequalities in first hospitalizations due to cardiovascular disease (CVD) from 1993 to 2010 among middle-aged women and men in Northern Sweden.

METHODS: The study comprised repeated cross-sectional register data from year 1993-2010 of all individuals aged 38-62 years enrolled in the Västerbotten Intervention Programme (VIP). Data included highest educational level, total earned income and first-time hospitalization for CVD from national registers. The relative and slope indices of inequality (RII and SII, respectively) were used to estimate educational and income inequalities in CVD for six subsamples for women and men, and interaction analyses were used to estimate trends across time periods.

RESULTS: Educational RII and SII were stable in women, while they decreased in men. Income inequalities in CVD developed differently compared with educational inequalities, with RII and SII for both men and women increasing during the study period, the most marked for RII in women rising from 1.52 in the 1990s to 2.62 in the late 2000s.

CONCLUSIONS: The trend of widening income inequalities over 18 years in the middle-aged in Northern Sweden, in the face of stable or even decreasing educational inequalities, is worrisome from a public health perspective, especially as Swedish authorities monitor socioeconomical inequalities exclusively by education. The results show that certain social inequalities in CVD rise and persist even within a traditionally egalitarian welfare regime.

Keywords
Inequalities, Sweden, cardiovascular diseases, education, income
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Social Medicine; Epidemiology
Identifiers
urn:nbn:se:umu:diva-154002 (URN)10.1177/1403494818790406 (DOI)30113264 (PubMedID)
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2020-04-22Bibliographically approved
Mamani-Ortiz, Y., Gustafsson, P. E., San Sebastián Chasco, M., Armaza Céspedes, A. X., Luizaga López, J. M., Illanes Velarde, D. E. & Mosquera Méndez, P. A. (2019). Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach. International Journal for Equity in Health, 18(1), Article ID 153.
Open this publication in new window or tab >>Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach
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2019 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, no 1, article id 153Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Social inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide.

OBJECTIVE: The aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities.

METHODS: An intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1.

RESULTS: The prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role.

CONCLUSION: Our study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Obesity, Gender, Ethnic, Intersectionality, Health inequality, Decomposition analysis, Bolivia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164917 (URN)10.1186/s12939-019-1062-7 (DOI)000490424100002 ()31615512 (PubMedID)2-s2.0-85073295885 (Scopus ID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-13Bibliographically approved
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