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  • 1.
    Lestari, Septi K
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Kowal, Paul
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 8, article id 1341Article in journal (Refereed)
    Abstract [en]

    The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

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  • 2.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Guerrero, Esteban
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Jingar, Monika
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Richter Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The STAR-C Intelligent Coach: a Cross- Disciplinary Design Process of a Behaviour Change Intervention in Primary Care2020In: pHealth 2020: Proceedings of the 17th International Conference on Wearable Micro and Nano Technologies for Personalized Health / [ed] Blobel, B., Lhotska, L., Pharow, P., Sousa, F., IOS Press, 2020, Vol. 273, p. 203-208Conference paper (Refereed)
    Abstract [en]

    A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.

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  • 3.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Santosa, Ailiana
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wilopo, Siswanto Agus
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Is Self-Rated Health an Independent Index for Mortality among Older People in Indonesia?2012In: PLOS ONE, E-ISSN 1932-6203, Vol. 7, no 4, p. e35308-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia.

    METHODS: In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES).

    RESULTS: During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04-1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0-4.4) and 4.9 (95% CI = 3.2-7.4), respectively. Education and SES did not modify this association for either sex.

    CONCLUSIONS: This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions.

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  • 4.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Kowal, P.
    Sitting time and obesity among older adults in low- and middle-income countries2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 415-416Article in journal (Other academic)
    Abstract [en]

    Background: Global industrialisation and economic development lead to changes in physical activity patterns with more sedentary behaviours and increasing sitting time, which are related to obesity. This study aims to identify the association between sedentary behaviour and obesity among older people aged 50+ in six low- and middle-income countries.

    Methods: This study utilises data from the WHO's Study on Global Ageing and Adult Health in China, Ghana, India, Mexico, the Russian Federation and South Africa. Physical activity level was measured using the Global Physical Activity Questionnaire Version 2 and daily sitting time was recorded in hour. Overweight and obesity was measured through height and weight, with BMI > =25. We conducted logistic regression to analyse the association between physical activity level and total daily sitting time and obesity, controlling for age, sex, highest education level, and living area.

    Results: Overweight and obesity prevalence ranged from 14% in India to 76% in the Russian Federation, and was significantly higher among women. The prevalence of low-to-moderate physical activity ranged from 36% in Ghana to 76% in South Africa. About 25% of the Russian population sat 2 hours or less daily, in contrast to 83% of the Mexican population who did so. Sitting more than 2 hours a day increased the odds of overweight and obesity (odds ratio 1.18; 95% confidence interval 1.09-1.29). The associated odds were 1.21 (95%CI 1.08-1.35) and 1.41 (95%CI 1.27-1.56) for those with moderate and low physical activity, compared to those who were more active.

    Conclusions: Independent of physical activity level during work, leisure and transport, longer daily sitting time is significantly associated with obesity among older adults. Public health intervention to promote physical activity among older people is crucial in preventing premature chronic disease deaths and promoting active and healthy ageing.

    Key messages:

    • The levels of sedentary behaviours among older people in low-and middle-income country are worrying, and are significantly associated with the level of obesity.
    • Reducing sitting time and promoting physical activity among older people are essential strategies to prevent obesity and its impacts on chronic disease and ensuring an active and healthy ageing.
  • 5.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography.
    Living alone and mortality among older people in Västerbotten County in Sweden: a survey and register-based longitudinal study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Living alone is increasingly common and has been depicted as an important cause of mortality. We examined the association between living alone and mortality risks among older men and women in northern Sweden, by linking two unique longitudinal datasets.

    METHODS: We used the Linnaeus database, which links several population registers on socioeconomic and health. This register-based study included 22,226 men and 23,390 women aged 50 and 60 years in Västerbotten County who had participated in the Västerbotten Intervention Program (VIP) during 1990-2006, with a total of 445,823 person-years of observation. We conducted Cox-proportional hazard regression to assess the risk of living alone on the mortality that was observed between 1990 and 2015, controlling for socio-demographic factors, chronic disease risk factors and access to social capital.

    RESULTS: Older men and women who lived alone with no children at home were at a significantly higher risk of death compared to married/cohabiting couples with children at home (with an adjusted hazard ratio of 1.38, 95% CI of 1.26-1.50 in men and 1.27, 95% CI of 1.13-1.42 in women). Living alone was an even stronger factor than the well-established chronic disease risk factors and a lack of access to social capital.

    CONCLUSIONS: A significant association between living alone and mortality among the older adult population in Sweden was observed. Providing good social support for older people is important in preventing the negative health impact of living alone.

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  • 6.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    A better world towards convergence of longevity?2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10076, p. 1278-1279Article in journal (Other academic)
  • 7.
    Santosa, Ailiana
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Where are the world’s disease patterns heading?: The challenges of epidemiological transition2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    INTRODUCTION: Epidemiological transition theory, first postulated by Omran in 1971, provides a useful framework for understanding cause-specific mortality changes and may contribute usefully to predictions about cause-specific mortality. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners due to lack of evidence from low- and middle-income countries. Therefore, understanding of the concept and development of epidemiological transition theory as well as population burden of premature mortality attributable to risk factors is needed.

    OBJECTIVES: This thesis aims to understand how epidemiological transition theory has been applied in different contexts, using available evidence on mortality transitions from high, middle- and low- income countries, as well as the contribution of risk factors to mortality transitions, particularly for premature mortality.

    METHODS: A Medline literature search from 1971 to 2013 was conducted to synthesise published evidence on mortality transition (paper I). A descriptive analysis of trends in cause of death using INDEPTH data was conducted, focusing on specific causes of death in 12 INDEPTH sites in Africa and Asia, using the INDEPTH 2013 standard population structure for appropriate comparisons across sites (paper II). A retrospective dynamic cohort database was constructed from Swedish population registers for the age range 30-69 years during 1991-2006, to measure reductions in premature non-communicable disease mortality using a life table method (paper III). Prospective cohort data from Västerbotten Intervention Programme from 1990 to 2006 were used to measure the magnitude of premature non-communicable disease mortality reductions associated with risk factor changes for each period of time (paper IV).

    FINDINGS: There were changes in emphasis in research on epidemiological transition over the four decades from 1971 to 2013, from cause of death to wide-ranging aspects of the determinants of mortality with increasing research interests in low-and middle-income countries, with some unconsidered aspects of social determinants contributing to deviations from classic theoretical pathways. Mortality rates declined in most sites, with the annual reductions in premature adult mortality varied across INDEPTH sites, Sweden, which now is at late stage of epidemiological transition stage, achieved a 25% reduction in premature mortality during 1991-2006. Overall downward trends in risk factors have helped to reduce premature mortality in the population of Västerbotten County, but some benefits were offset by other increasing risks. The largest mortality changes accrued from reductions in smoking, hypertension and hypercholesterolaemia.

    CONCLUSIONS: This thesis established patterns of current epidemiological transition in high, middle-and low-income countries (Asia and Africa), where the theory fits the transition patterns in some countries, but with some needs for further adjustments in other settings, as well as deviations from the classical ET theory in the last four decades. It highlights the need to identify the burden of mortality and morbidity, particularly for reducing mortality occurring before the age of 70 years and its attribution to risk factors, which are a major public health challenge. This informs shifting of public health priorities and resources towards prevention and control of chronic non-communicable disease risk factors.

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  • 8.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Diverse empirical evidence on epidemiological transition in low- and middle-income countries: population-based findings from INDEPTH Network data2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155753Article in journal (Refereed)
    Abstract [en]

    Background Low-and middle-income countries are often described as being at intermediate stages of epidemiological transition, but there is little population-based data with reliable cause of death assignment to examine the situation in more detail. Non-communicable diseases are widely seen as a coming threat to population health, alongside receding burdens of infection. The INDEPTH Network has collected empirical population data in a number of health and demographic surveillance sites in low-and middle-income countries which permit more detailed examination of mortality trends over time.

    Objective To examine cause-specific mortality trends across all ages at INDEPTH Network sites in Africa and Asia during the period 1992-2012. Emphasis is given to the 15-64 year age group, which is the main focus of concern around the impact of the HIV pandemic and emerging non-communicable disease threats.

    Methods INDEPTH Network public domain data from 12 sites that each reported at least five years of cause-specific mortality data were used. Causes of death were attributed using standardised WHO verbal autopsy methods, and mortality rates were standardised for comparison using the INDEPTH standard population. Annual changes in mortality rates were calculated for each site.

    Results A total of 96,255 deaths were observed during 9,487,418 person years at the 12 sites. Verbal autopsies were completed for 86,039 deaths (89.4%). There were substantial variations in mortality rates between sites and over time. HIV-related mortality played a major part at sites in eastern and southern Africa. Deaths in the age group 15-64 years accounted for 43% of overall mortality. Trends in mortality were generally downwards, in some cases quite rapidly so. The Bangladeshi sites reflected populations at later stages of transition than in Africa, and were largely free of the effects of HIV/AIDS.

    Conclusions To some extent the patterns of epidemiological transition observed followed theoretical expectations, despite the impact of the HIV pandemic having a major effect in some locations. Trends towards lower overall mortality, driven by decreasing infections, were the general pattern. Low-and middle-income country populations appear to be in an era of rapid transition.

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  • 9. Santosa, Ailiana
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Study Protocol: Social capital as a resource for the planning and design of socially sustainable and health promoting neighbourhoods: A mixed method study2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 581078Article in journal (Refereed)
    Abstract [en]

    Introduction: Promoting inclusive, safe, resilient, and sustainable communities is one of the 17 Sustainable Development Goals ratified in 2015 by 193 UN member states, not least in Sweden. Social sustainability involves preserving particular societal values (e.g., local identity) as well as developing values (e.g., social cohesion) that are perceived as needed. Socially sustainable development also implies promoting integration and preventing segregation. Social capital is one important indicator to measure how socially sustainable an area is. This project aims to explore how social capital can be used as a conceptual tool in developing housing policy for social sustainability in Umeå Municipality.

    Methods: The three sub-studies in this project combine quantitative and qualitative methods. We will conduct a review of the municipality’s documents to understand how the ideas of social sustainability have influenced political declarations and implemented social and housing policies and interventions during the period 2006–2020. The quantitative study includes a longitudinal follow-up to the 2006 survey’s respondents to assess the longitudinal impacts of neighborhood social capital on health and well-being; as well as a new repeated cross-sectional survey to investigate how social capital has changed in local neighborhoods from 2006 to 2020. The qualitative study includes case studies in neighborhoods with different social capital dynamics to understand how different resident sub-groups perceive their neighborhoods and how implemented social and housing policies have influenced the social capital dynamics and responded to the needs of different sub-groups. The project is run in close collaboration with the Commission for a Socially Sustainable Umeå.

    Discussions: This project will create new and unique perspectives on long-term structural changes of relevance for a socially sustainable housing policy; knowledge that is highly valuable for continuous municipal planning; and will outline recommendations to guide local housing policies for social sustainable neighborhoods in Umeå Municipality.

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  • 10.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study2015In: BMC Medicine, E-ISSN 1741-7015, Vol. 13, no 65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally.

    OBJECTIVES: We firstly considered whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes or chronic respiratory diseases) had already taken place in Sweden during an equivalent 15-year period. Secondly, we assessed which population sub-groups had been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.

    METHODS: A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30-69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.

    RESULTS: A total of 292,320 deaths occurred in the 30-69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002 and 2003-2006.

    CONCLUSIONS: Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25x25 target, particularly where substantial premature mortality reductions have already been achieved.

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  • 11.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, Ulf
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socio-demographic predictors of mortality inequality among Swedish men and women: a longitudinal study2014In: 7th European Public Health Conference Mind the gap: Reducing inequalities in health and health care Glasgow, 19–22 November 2014, Oxford University Press, 2014, Vol. 24, p. 188-189Conference paper (Refereed)
    Abstract [en]

    Background: Despite increasing life expectancy in many countries, health and mortality inequality exist. This study aimed to assess overall and cardiovascular (CVD) mortality trends among Swedish men and women during 1992-2006, and their association with individual level socio-demographic determinants of mortality inequality.

    Methods: Data were extracted from the Linnaeus Database which consists of register and survey data. A multilevel Poisson regression analysis was used to assess the number and mortality rate, as well as individual level determinants (fixed effects) of overall and CVD deaths for men and women at county level (n = 24) in each 5-year period during 1992-2006. We also assessed the random effect at county level.

    Results: A total of 9,098,090 individuals accumulating 115,361,104 person years was included in this study. A significant reduction in overall and CVD mortality rates occurred among Swedish men and women during the study period 1992-2006, with persisting excess male: female mortality. Older age and pensioner, unmarried or widowed individuals, low and middle education levels and employed individuals with low income (the lowest income tertile) were consistently associated with higher mortality rates of overall and CVD mortality in men and women. Individuals with tertiary education level and being immigrant was protective factors for overall mortality, but less so for CVD mortality. The multilevel analysis revealed that about 85% and 80% of the variation of overall and CVD mortality at county level, respectively, could be explained by the individual socio-demographic variables.

    Conclusions: Inequality in overall and CVD mortality still exists among Swedish men and women, and to some extend are influenced by county level determinants. Contextual epidemiology must therefore play a decisive role in understanding social disparities in overall and CVD mortality in Sweden.

    Key messages:

    • Overall, individual factors played a more important part in understanding the differences of overall and CVD mortality than contextual factors within the same area in men and women in Swedish context.

    • Health policy actions aiming to reduce health inequality should be addressed not only focusing on individual characteristics but also on geographical factors.

  • 12.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    What kills middle-aged Swedes? Non-communicable disease risk factors and mortality in a prospective population cohort studyManuscript (preprint) (Other academic)
  • 13.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vaezghasemi, Masoud
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Inequality in disability-free life expectancies among older men and women in six countries with developing economies2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 855-861Article in journal (Refereed)
    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.

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  • 14.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Fottrell, Edward
    Institute for Global Health, University College London, London, UK.
    Högberg, Ulf
    Department of Women’s and Children’s Health, Uppsala University, Uppsala.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research and MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    The development and experience of epidemiological transition theory over four decades: a systematic review2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23574Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions.

    DESIGN: A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources.

    RESULTS: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory.

    CONCLUSIONS: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

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  • 15.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden.
    Zhang, Yue
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zhao, Genming
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
    Wang, Na
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
    Zhao, Qi
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
    Wang, Weibing
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China. wwb@fudan.edu.cn.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden.
    Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 1763Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Failure to promote early detection and better management of hypertension will contribute to the increasing burden of cardiovascular diseases. This study aims to assess the gender differences in the prevalence, awareness, treatment and control of hypertension, together with its associated factors, in China and Sweden.

    METHODS: We used data from two cross-sectional studies: the Västerbotten Intervention Program in northern Sweden (n = 25,511) and the Shanghai survey in eastern China (n = 25,356). We employed multivariable logistic regression to examine the socio-demographics, lifestyle behaviours, and biological factors associated with the prevalence, awareness, treatment and control of hypertension.

    RESULTS: Men had a higher prevalence of hypertension (43% in Sweden, 39% in China) than their female counterparts (29 and 36%, respectively). In Sweden, men were less aware of, less treated for, and had less control over their hypertension than women. Chinese men were more aware of, had similar levels of treatment for, and had less control over their hypertension compared to women. Awareness and control of hypertension was lower in China compared to Sweden. Only 33 and 38% of hypertensive Chinese men and women who were treated reached the treatment goals, compared with a respective 48 and 59% in Sweden. Old age, impaired glucose tolerance or diabetes, a family history of hypertension or cardiovascular diseases, low physical activity and overweight or obesity were found to increase the odds of hypertension and its diagnosis.

    CONCLUSIONS: This study shows the age and gender differences in the prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. Multisectoral intervention should be developed to address the increasing burden of sedentary lifestyle, overweight and obesity and diabetes, all of which are linked to the prevention and control of hypertension. Development and implementation of the gender- and context-specific intervention for the prevention and control of hypertension facilitates understanding with regard to the implementation barriers and facilitators.

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  • 16.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Hakimi, Mohammad
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Cross-sectional survey of sexual dysfunction and quality of life among older people in Indonesia2011In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, no 6, p. 1594-1602Article in journal (Refereed)
    Abstract [en]

    Introduction.  The burden of sexual dysfunction among older people in many low- and middle-income countries is not well known. Understanding sexual dysfunction among older people and its impact on quality of life is essential in the design of appropriate health promotion programs.

    Aims.  To assess levels of sexual function and their association with quality of life while controlling for different sociodemographic determinants and chronic diseases among men and women over 50 years of age in rural Indonesia.

    Methods.  A cross-sectional study was conducted in the Purworejo District, Central Java, Indonesia in 2007. The study involved 14,958 men and women over 50 years old. The association between sexual dysfunction and quality of life after controlling for potential confounders (e.g., sociodemographic determinants and self-reported chronic diseases) was analyzed by multivariable logistic regression.

    Main Outcome Measures.  Self-reported quality of life.

    Results.  Older men more commonly reported sexual activity, and sexual problems were more common among older women. The majority of older men and women reported their quality of life as good. Lack of sexual activity, dissatisfaction in sexual life, and presence of sexual problems were associated with poor self-reported quality of life in older men after adjustment for age, marital status, education, and history of chronic diseases. A presence of sexual problems was the only factor associated with poor self-reported quality of life in women. Being in a marital relationship might buffer the effect of sexual problems on quality of life in men and women.

    Conclusion.  Sexual dysfunction is associated with poor quality of life among older people in a rural Javanese setting. Therefore, promotion of sexual health should be an integral part of physical and mental health campaigns in older populations.

  • 17.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Santosa, Ailiana
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ng, Nawi
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Matilda
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Impact of COVID-19 on neighborhood social support and social interactions in Umeå municipality, Sweden2021In: Frontiers in Sustainable Cities, E-ISSN 2624-9634, Vol. 3, article id 68573Article in journal (Refereed)
    Abstract [en]

    The objectives are to, for neighborhoods with different levels of social capital, (1) map out the levels of social interactions, emotional support, and instrumental support before the COVID-19 crisis, (2) analyze how social interactions, emotional support, and instrumental support had changed during the pandemic and, (3) analyze changes in self-rated health during the pandemic. This study is based on a telephone survey with a subsample of 168 respondents in Umeå municipality who participated in a large base-line social capital survey in 2006. We asked whether neighbors talk to, care for, and help each other, before and during the Covid crisis. Individuals rated their health as poor or good. We compared people's self-rated health and their perceptions about their neighborhoods between those who lived in high or low/medium social capital neighborhoods. Before the pandemic, participants in high social capital neighborhoods reported more active neighborhood interaction and support. During the crisis, social interaction and support increased in all neighborhoods, but more in high social capital neighborhoods. Overall, people seemed to help and care for each other more during than before the crisis. More individuals in the high social capital neighborhoods reported improvement in their health during the pandemic, than those in the low/medium social capital neighborhoods. Our findings indicate that neighborhoods social capital can be strengthened during a crisis, in particular in areas with existing high levels of social capital. The findings need to be interpreted carefully due to its small sample size but observed patterns warrant further investigation.

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  • 18. Zhang, Yue
    et al.
    Santosa, Ailiana
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wang, Na
    Wang, Weibing
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zhao, Qi
    Jiang, Yonggen
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zhao, Genming
    Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study2019In: Diabetes Therapy, ISSN 1869-6953, E-ISSN 1869-6961, Vol. 10, no 6, p. 2061-2077Article in journal (Refereed)
    Abstract [en]

    Introduction: Understanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden.

    Methods: This study enrolled 25,356 adults (35–64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population.

    Results: Chinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women.

    Conclusions: Chinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.

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