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Background: Opioid-related overdose deaths remain a common cause of death in many settings, and opioid maintenance treatment is evidence-based for the treatment of opioid use disorders. However, access to such treatment varies and is limited in many settings. Methods: The present study examines the longitudinal effects of a regional patient choice reform which substantially increased availability to opioid maintenance treatment in one Swedish county, starting from 2014. A previous follow-up, limited in time, indicated a possible effect on mortality from this intervention, demonstrating a lower increase in overdose deaths than in counties without this reform. The present study follows overdose deaths through 2021, and compares the intervention county to the remaining parts in the country, using death certificate statistics from the national causes of death register. Results: The present study does not demonstrate any significant difference in the development of overdose mortality in the county where this reform substantially expanded treatment access, compared to other counties in the country. Conclusions: The study underlines the importance to maintain extensive efforts against overdose deaths over and above the treatment of opioid use disorders, such as low-threshold provision of opioid antidotes or other interventions specifically addressing overdose risk behaviors. [ABSTRACT FROM AUTHOR]

In 2010, the Swedish Civil Contingencies Agency (MSB) announced a "vision zero" of zero fire deaths in Sweden by 2050. Studies into fire deaths have identified that certain risk groups, including but not limited to older people, are overrepresented in fire death statistics in Sweden. The MSB has developed guidelines for how individualised fire safety (IFS) can be implemented in local communities for risk groups, in support of their vision zero for fire deaths. This paper presents the results of an interview study with a selection of Swedish municipalities to further explore how municipalities are working with IFS programs for community dwelling older people. The Consolidated Framework for Implementation Research has been used to analyse data developed through semi-structured interviews, from an analysis of the delegation of authority from MSB to local level and assessment of secondary documentation from national, regional and local organisations. The analysis has identified that IFS has, indeed, been implemented to varying degrees in Sweden, but that there are both facilitators and barriers which can be further leveraged to improve the implementation of IFS in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND Previous research has shown that the health transition and demographical pattern of indigenous people has followed a different path compared to non-indigenous groups living in the same area with higher mortality rates and shortened life expectancy at birth. OBJECTIVE This paper draws attention to the development of life expectancy for the Sami and non-Sami during the colonization era (1850-1899). The paper will compare the development of life expectancy levels, infant mortality, and age-specific mortality between the Sami and the non-Sami population and analyze the main causes of death. METHODS The source material for this study is a set of data files from the Demographic Data Base (DDB) at Umeå University. Life tables and calculations of values of life expectancies are calculated using period data. RESULTS The analysis reveals that the life expectancy at birth was remarkably lower for the Sami during the entire period, corresponding to a high infant mortality. When comparing life expectancy at birth with life expectancy at age one, Sami still had a lower life expectancy during the entire period. The analysis also reveals a lower proportion of deaths due to infections among the younger Sami. CONCLUSIONS The results paint a complex picture of the demographic transition in Sápmi. Neither the Sami nor the non-Sami population followed the same pattern of increased life expectancies at birth, as the Swedish population did in general. The negative consequences of colonization (high mortality, low life expectancy at birth) hit the Sami and non-Sami populations, but at different time periods. [ABSTRACT FROM AUTHOR]

Background: Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. Objectives: To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). Design: Population-based prospective cohort study. Methods: Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002–2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine–Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. Results: The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31–2.02 and 1.24, 1.06–1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05–6.82 and 1.40, 1.04–1.90). The hazard of respiratory death was significant in women (3.41, 1.05–11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01–2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05–6.82) but not for cardiovascular death (1.11, 0.74–1.66), with a similar pattern in both sexes. Conclusion: The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes. Plain language summary: All-cause and cause specific mortality in relation to different lung function patterns and sex; normal, obstructive and restricted lung function Chronic airway obstruction and restrictive spirometry pattern are associated with mortality, but sex specific patterns have hardly been evaluated. Aim: To study possible sex-dependent differences of all-cause and cause-specific mortality among men and women with chronic airway obstruction and restrictive spirometry pattern, respectively, compared to that of normal lung function. Methods: Individuals with chronic airway obstruction, restrictive spirometry pattern and normal lung function were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-04. Mortality data were collected through April 2016, totally covering 19,000 patient-years of observation time. We analyzed the Hazard Ratios for all-cause and cause-specific death comparing chronic airway obstruction and restrictive spirometry pattern to that of normal lung function, adjusting for age, body mass index, sex, smoking habits and pack-years. Similar analyses were conducted separately for men and women. Results: The hazard for all-cause mortality was higher in both chronic airway obstruction and restrictive spirometry pattern than in normal lung function and, the higher hazards were male-driven. In chronic airway obstruction the hazard of respiratory and cardiovascular deaths higher than in those with normal lung function. The increased hazard of respiratory death was significant in women while the increased hazard of cardiovascular death was significant in men. In restrictive spirometry pattern, the higher hazard for respiratory but not cardiovascular death persisted after adjustment, similarly in both sexes. Conclusions: The higher hazard for all-cause mortality in chronic airway obstruction and restrictive spirometry pattern than in normal lung function was male-driven. Chronic airway obstruction associated with respiratory death in women and cardiovascular death in men, while restrictive pattern associated with respiratory death, similarly in both sexes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has highlighted a debate about whether marginalized communities suffered the disproportionate brunt of the pandemic's mortality. Empirical studies addressing this question typically suffer from statistical uncertainties and potential biases associated with uneven and incomplete reporting. We use geo-coded micro-level data for the entire population of Sweden to analyze how local neighborhood characteristics affect the likelihood of dying with COVID-19 at individual level, given the individual's overall risk of death. We control for several individual and regional characteristics to compare the results in specific communities to overall death patterns in Sweden during 2020. When accounting for the probability to die of any cause, we find that individuals residing in socioeconomically disadvantaged neighborhoods were not more likely to die with COVID-19 than individuals residing elsewhere. Importantly, we do find that individuals show a generally higher probability of death in these neighborhoods. Nevertheless, ethnicity is an important explanatory factor for COVID-19 deaths for foreign-born individuals, especially from East Africa, who are more likely to pass away regardless of residential neighborhood. [ABSTRACT FROM AUTHOR]

This paper presents some new and unique cross-county data from 19th-century Sweden over birth, death, and marriage rates, grain prices, and harvests. Local grain prices correlate negatively with local harvests, suggesting imperfectly integrated food markets. The so-called positive and preventive checks are also present: good local harvests are associated with high birth and marriage rates, and low death rates. We also find that the fertility and marriage effects from changes in prices -- but not harvests -- are greater in counties that rely more on manufacturing, consistent with an open-economy model of fertility choice, where agents earn income from both agriculture and manufacturing. [ABSTRACT FROM AUTHOR]

Sweden's strategy to contain the COVID-19 pandemic stands out internationally as more liberal in terms of not ordering a complete lockdown of society. Sweden kept its primary schools, daycare centers and industries largely open. The government financially supported furloughed workers and increased its support to regional and local governments delivering healthcare and elderly care. However, the death toll in Sweden which passed 4000 by late May 2020 stands in stark contrast to those of other, comparable countries, raising questions about the design of the strategy, and its appropriateness. The paper argues that key assumptions sustaining the strategy, for instance that symptom-free people do not carry, and cannot transmit the Coronavirus, or that local and regional government staff had the necessary training and equipment to tackle the pandemic, along with problems associated with coordinating a decentralized healthcare system, may explain the poor performance of the Swedish containment strategy. [ABSTRACT FROM AUTHOR]

Purpose: This study introduces a novel method for estimating the variance of life expectancy since diagnosis (LEC) and loss in life expectancy (LLE) for cancer patients within a relative survival framework in situations where life tables based on the entire general population are not accessible. LEC and LLE are useful summary measures of survival in population-based cancer studies, but require information on the mortality in the general population. Our method addresses the challenge of incorporating the uncertainty of expected mortality rates when using a sample from the general population. Methods: To illustrate the approach, we estimated LEC and LLE for patients diagnosed with colon and breast cancer in Sweden. General population mortality rates were based on a random sample drawn from comparators of a matched cohort. Flexible parametric survival models were used to model the mortality among cancer patients and the mortality in the random sample from the general population. Based on the models, LEC and LLE together with their variances were estimated. The results were compared with those obtained using fixed expected mortality rates. Results: By accounting for the uncertainty of expected mortality rates, the proposed method ensures more accurate estimates of variances and, therefore, confidence intervals of LEC and LLE for cancer patients. This is particularly valuable for older patients and some cancer types, where underestimation of the variance can be substantial when the entire general population data are not accessible. Conclusion: The method can be implemented using existing software, making it accessible for use in various cancer studies. The provided example of Stata code further facilitates its adoption. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has not affected the population evenly. This must be acknowledged when it comes to understanding the Covid-19 death toll and answering the question of how many life years have been lost. We use level of geriatric care to account for variation in remaining life expectancy among individuals that died during 2020. Based on a linkage of administrative registers, we estimate remaining life expectancy stratified by age, sex, and care status using an incidence-based multistate model and analyze the number of years of life lost (YLL) during 2020 in Sweden. Our results show that remaining life expectancy between individuals with and without care differs substantially. More than half of all Covid-19 deaths had a remaining life expectancy lower than 4 years. Yet, in a 1-year perspective, Covid-19 did not seem to replace other causes of death. Not considering the differences in remaining life expectancy in the affected populations overestimated YLL by 40% for women and 30% for men, or around 2 years per death. While the unadjusted YLL from Covid-19 amounted to an average of 7.5 years for women and 8.6 years for men, the corresponding YLL adjusted for care status were 5.4 and 6.6, respectively. The total number of YLL to Covid-19 in 2020 is comparable to YLL from ischemic heart disease in 2019 and 2020. Our results urge the use of subgroup specific mortality when counting the burden of Covid-19. YLL are considerably reduced when the varying susceptibility for death is considered, but even if most lifespans were cut in the last years of life, the YLL are still substantial. [ABSTRACT FROM AUTHOR]

Despite the fact that the increasing involvement of the private sector in pension provision has brought more flexibility to the pay-out phase of retirement, little is known about the characteristics of those who choose to annuitize their pension wealth and those who do not. I combine unique micro-data from a large Swedish occupational pension plan with rich national administrative data to study the choice between life annuities and fixed-term payouts with a minimum payout length of 5 years for 183,000 retiring white-collar workers. I find that low accumulation of assets is strongly associated with the choice of the 5-year payout. Consistent with individuals selecting payout length based on private information about their mortality prospects, individuals who choose the 5-year payout are in worse health, exhibit higher ex-post mortality rates and have shorter-lived parents than annuitants. Individuals also seem to respond to large, tax-induced changes in annuity prices. [ABSTRACT FROM AUTHOR]

Using the synthetic control method, we construct counterfactuals for what would have happened if Sweden had imposed a lockdown during the first wave of the COVID-19 epidemic. We consider eight different indicators, including a novel one that we construct by adjusting recorded daily COVID-19 deaths to account for weakly excess mortality. Correcting for data problems and re-optimizing the synthetic control for each indicator, we find that a lockdown would have had sizable effects within one week. The much longer delay estimated by two previous studies focusing on the number of positives cases is mainly driven by the extremely low testing frequency that prevailed in Sweden in the first months of the epidemic. This result appears relevant for choosing the timing of future lockdowns and highlights the importance of looking at several indicators to derive robust conclusions. We also find that our novel indicator is effective in correcting errors in the COVID-19 deaths series and that the quantitative effects of the lockdown are stronger than previously estimated. [ABSTRACT FROM AUTHOR]

Background: Incidence estimates of subarachnoid haemorrhage (SAH) in Sweden vary, which may be caused by regional variations. Reliable estimates of age-specific case fatality rates are lacking. We analysed regional incidence rates and case fatality rates of SAH in Sweden. Methods: The Swedish Hospital Discharge and Cause of Death Registries from 1987 to 2002 yielded data on 18 443 patients with SAH. Incidence and case fatality rates by age, gender, region and time period were calculated by Poisson regression. Results: The incidence rate was 12.4 per 100 000 person-years (95% CI 12.2 to 12.6) and increased with age, from 6.4/100 000 person-years in patients who were 30-39 years old to 25.8/100 000 person-years in patients who were older than 80 years. Incidence was higher for women (14.4 (95% CI 14.2 to 14.7)) than for men (10.3 (95% Cl 10.3 to 10.6)), and higher in the north than in the south (AR 1.31 (95% CI 1.25 to 1.37)). This geographical gradient was more evident in women (AR 1.41)95% CI 1.33 to 1.49)) than in men (AR 1.23 (95% CI 1.15 to 1.33)). The 28-day case fatality rate was 31.7% (95% CI 31.0 to 32.3). It increased with age from 18.1% (95% Cl 16.0 to 20.3) in patients who were 30-39 years old to 57.6% (95% CI 55.2 to 59.9) in patients over 80 years, then levelling off. Over time (1995-2002 compared with 1987-1994), the incidence rate decreased (AR 0.93 (95% CI 0.90 to 0.96)) and case fatality rate decreased (AR 0.89 (95% CI 0.85 to 0.93)). Conclusions: SAH incidence rates in Sweden increase from south to north, more in women than in men. Octogenarians have a quadrupled incidence and a tripled case fatality compared with young adults. During 16 years, both incidence and case fatality have decreased. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. In surgical management of CSDH, there is a lack of standardized guidelines concerning surgical techniques and a lack of consensus on which technique(s) are optimal. Neurosurgical centers have shown a wide variation in surgical techniques. The purpose of this study was to compare two different surgical techniques, one burr hole craniostomy with an active subgaleal drain (BHC) and minicraniotomy with a passive subdural drain (MC). Methods: We conducted a multicenter retrospective cohort study at two neurosurgical centers in Sweden which included patients with unilateral CSDHs that received surgical treatment with either BHC or MC. The primary outcomes in comparison of the techniques were 30-day mortality, recurrence rate, and complications according to the Landriel Ibañez grading system for complications. Results: A total of 1003 patients were included in this study. The BHC subgroup included 560 patients, and the MC subgroup included 443 patients. A 30-day mortality when comparing BHC (2.3%) and MC (2.7%) was similar (p = 0.701). Comparing recurrence rate for BHC (8.9%) and MC (10.8%) showed no significant difference (p = 0.336). We found that medical complications were significantly more common in the MC group (p = 0.001). Surgical complications (type IIb) was also associated with the MC group (n = 10, p = 0.003). Out of the 10 patients with type IIb complications in the MC group, 8 had postoperative acute subdural hematomas. Conclusions: BHC was comparable to MC concerning 30-day mortality rate and recurrence rates. We did, however, find that MC was significantly associated with medical complications and serious surgical postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has put an exceptional strain on intensive care units worldwide. During the first year, the survival of patients with acute hypoxaemic respiratory failure appears to have improved. We aimed to describe the mortality rates, management characteristics and two pandemic waves during the first year at three non‐academic rural intensive care units in Sweden. Methods: We retrospectively analysed all cases of COVID‐19 admitted to intensive care units in Region Jönköping County during 1 year. The primary endpoint was 30‐day mortality. Results: Between 14th March 2020 and 13th March 2021, 264 patients were admitted to undergo intensive care with confirmed SARS‐CoV‐2 infection. The 30‐day mortality rate after the initial intensive care admission was 12.9%, and this rate remained unchanged during both pandemic waves. However, we found several distinct differences between the two pandemic waves, including an increase in the use of high‐flow nasal oxygen but a decrease in invasive mechanical ventilation use, biochemical markers of inflammation, continuous renal replacement therapy and length of stay in the intensive care unit. Conclusion: Our study showed that critically ill patients with COVID‐19 in Sweden have a low 30‐day mortality rate which compares well with results published from academic centres and national cohorts throughout Scandinavia. During the second pandemic wave, the proportion of patients receiving invasive mechanical ventilation and continuous renal replacement therapy was lower than that in the first wave. This could be the result of increased knowledge and improved therapeutic options. [ABSTRACT FROM AUTHOR]

Aims: The methods chosen for seeking the answers to questions on social inequalities in health may heavily influence the results and thereby the formulation of appropriate public health policies. This study aims at identifying methodological problems in analysing trends about socio-economic differences in health. The focus is on whether the results may be influenced by the choice of outcome measure, the choice of social groups or by changes in the composition of social groups over time. Methods: Data sets on socio-economic differences in mortality in Europe presented by Kunst et al. and also data sets from the Swedish Survey of Living Conditions have been used. Results: The choice of outcome measures influences the results. Mortality trend comparisons between European countries for different socio-economic groups give completely different pictures whether using relative or absolute figures. The generally lower death rate in Sweden means that even small absolute differences give higher relative differences than in countries with higher death rates. Using socio-economic group or educational level as indicators of social position showed quite different results when analysing social inequalities in smoking and overweight in Sweden. The structure of social groups changes over time making trend analysis more difficult to interpret. In Sweden the group of poorly-educated people has halved in size during the past two decades, and the group of highly-educated people has increased. These changes most likely make the poorly-educated group a more homogenous and -healthwise - a more negatively selected group than it was twenty years ago. Conclusions: The most appropriate scientific approach to this problem is to present basic data in terms of absolute figures per population before presenting relative or absolute differences. [ABSTRACT FROM AUTHOR]

Introduction: Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods: Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results: In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974–0.978), and 1.030 (1.023–1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144–1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007–1.011) and 1.083 (1.076–1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion: In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy. [ABSTRACT FROM AUTHOR]

Background: Predation and hunter harvest constitute the main mortality factors affecting the size and dynamics of many exploited populations. The re-colonization by wolves (Canis lupus) of the Scandinavian Peninsula may therefore substantially reduce hunter harvest of moose (Alces alces), the main prey of wolves. Methodology/Principal findings: We examined possible effects of wolf presence on hunter harvest in areas where we had data before and after wolf establishment (n = 25), and in additional areas that had been continuously exposed to wolf predation during at least ten years (n = 43). There was a general reduction in the total number of moose harvested (n = 31,827) during the ten year study period in all areas irrespective of presence of wolves or not. However, the reduction in hunter harvest was stronger within wolf territories compared to control areas without wolves. The reduction in harvest was larger in small (500-800 km2) compared to large (1,200-1,800 km2) wolf territories. In areas with newly established wolf territories moose management appeared to be adaptive with regard to both managers (hunting quotas) and to hunters (actual harvest). In these areas an instant reduction in moose harvest over-compensated the estimated number of moose killed annually by wolves and the composition of the hunted animals changed towards a lower proportion of adult females. Conclusions/Significance: We show that the re-colonization of wolves may result in an almost instant functional response by another large predator—humans—that reduced the potential for a direct numerical effect on the density of wolves’ main prey, the moose. Because most of the worlds’ habitat that will be available for future colonization by large predators are likely to be strongly influenced by humans, human behavioural responses may constitute a key trait that govern the impact of large predators on their prey. [ABSTRACT FROM AUTHOR]

The expected decline of health indicators with economic recessions and improvement with economic growth in the nineteenth century Sweden was reversed in the twentieth century, giving the counterintuitive pattern of higher mortality and lower life expectancy in economic expansions and improvement of these indices in recessions. The change or 'tipping point' occurred at the end of the nineteenth century or early in the twentieth century when electrification was introduced into Sweden. All 5 of the reversals of annual industrial electric energy use in the US between 1912 and 1970 were accompanied by recessions with lowered GDP, increased unemployment, decreased mortality and increased life expectancy. The health indices were not related to residential electricity use. The mortality improvement between 1931 and 1932 by state in the US strongly favored urban areas over rural areas. Rural unemployment by state in 1930 was significantly positively correlated with residential electrification percentage by state in 1930. The health effects of economic change are mediated by electrical exposure. [ABSTRACT FROM AUTHOR]

Background: In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the world's longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. Methods: We look at life expectancy over the years 1970–2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. Results: Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. Conclusions: Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground. [ABSTRACT FROM AUTHOR]

Objective:To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods:The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998–2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results:In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and minibuses during 1998 to 2008. The cause of death for a third of the victims was fire related, as burns and/or smoke inhalation injuries, with no fatal trauma injuries. Twenty-five of these 55 deaths were persons 19 years or younger and included 15 of 18 rear seat deaths. Over half of the 181 deaths were in vehicles that had collided with another vehicle and, of these cases, half were killed in collisions with heavy vehicles. The percentage of drivers with illegal blood alcohol concentrations (27%) and suicides (5.5%) were not higher than in other fatal crashes on Swedish roads. The ignition point of the fire was indicated in only half of the cases and, of those, half started in the engine compartment and one fourth started around the fuel tank or lines. Conclusions:Car fires are a deadly postcrash problem. Reducing this risk would be primarily a responsibility for the automotive industry. A multifactor approach could be considered as follows: risk-reducing design, insulation, reduced flammability in motor compartment fluids and plastics, and automatic fire extinguishing equipment. Inspiration could be found in how, for example, the auto racing and aviation industries handle this problem. [ABSTRACT FROM AUTHOR]

Background: There are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreign-born populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth. Material and Methods: We included all 72 333 patients undergoing a first isolated CABG in Sweden, during 1995 - 2007 of whom 12.7% were foreign-born. The patients were classified according to educational level, sex, and country of birth and were followed up to December 2007. We estimated the risk of short and long term mortality after CABG in a multivariable model adjusted for age, calendar year of surgery, diabetes, educational level, and waiting time for surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated based on the Cox proportional hazard model. Findings: There were 15,284 deaths during the follow-up, 10.4% of whom were foreign-born. The foreign-born patients were 3 to 4 years younger than Sweden-born patients at the time of CABG surgery. There were no significant differences in overall early or late mortality between foreign-born and Sweden-born men and women after CABG. All-cause mortality differed in between regions and was highest in foreign-born men from Eastern Africa (HR 3.80, 95% CI 1.58–9.17), China (HR 3.61, 95% CI 1.50–8.69), and in Chile (HR 2.12, 95% CI 1.01–4.47). Patients with low level of education had worse survival compared to those with longer than 12 years of education irrespective of sex and country of birth. This difference was more pronounced among foreign-born women (HR 1.50, 95% CI 1.00–2.33). Conclusion: This national study showed higher CABG mortality in patients from lower socioeconomic position. Early and late mortality did not differ after isolated CABG in foreign-born and Sweden-born patients. [ABSTRACT FROM AUTHOR]

In addition to own education and other socioeconomic resources, the education of one's children may be important for individual health and longevity. Mothers and fathers born between 1932 and 1941 were analyzed by linking them to their children in the Swedish Multi-generation Register, which covers the total population. Controlling for parents' education, social class, and income attenuates but does not remove the association between children's education and parents' mortality risk. Shared but unmeasured familial background characteristics were addressed by comparing siblings in the parental generation. In these fixed-effects analyses, comparing parents whose children had tertiary education with parents whose children completed only compulsory schooling (the reference group) yields a hazard ratio of 0.79 (95 % CI: 0.70-0.89) when the socioeconomic position of both parents is controlled for. The relationship is certainly not purely causal, but part of it could be if, for example, well-educated adult children use their resources to find the best available health care for their aging parents. I therefore introduce the concept of 'social foreground' and suggest that children's socioeconomic resources may be an important factor in trying to further understand social inequalities in health. [ABSTRACT FROM AUTHOR]

Aim. To map mortality and morbidity of poisonings in Denmark, Finland, Iceland, Norway and Sweden in 2007 and undertake a comparison with a corresponding study in 2002. Methods. Morbidity was as for 2002 defined as acute poisoning (ICD-10 codes, main and subsidiary diagnoses) treated in hospitals. The figures were extracted from the National Patient/Hospital Registers. Deaths recorded as acute poisoning (using corresponding ICD-10 codes) were collected from the National Cause of Death Registers. Results. Annual mortality of acute poisonings per 100000 inhabitants (rate) for 2007 was 22.4 in Finland, an important increase from 16.7 per 100000 in 2002. The increase was mainly due to a change in coding of alcohol, but also represented a slight increase in fatal alcohol intoxications per se. The poisoning death rate in the other Nordic countries varied between 8-13 and was at the same level as for 2002. The morbidity rates for 2007 between158-285 per 100000 inhabitants represented a slight increase compared to 2002 figures. Conclusion. The increase in poisoning death rate for alcohol, and thus total rate in Finland in 2007 compared to 2002, has further increased the gap to the other Nordic countries. Poisoning morbidity rates in the Nordic countries are of the same level, but the variability shown indicates that more harmonization and collaboration is needed to increase the data quality. [ABSTRACT FROM AUTHOR]

Background: Treatment of common bile duct stones has changed. Open surgery has gradually been replaced by endoscopic and laparoscopic procedures. The aims of this study were to see how common bile duct stones have been treated in Sweden, to establish whether there were differences in morbidity and mortality between these approaches, and to identify factors influencing mortality. Methods: All persons undergoing inpatient common bile duct exploration or endoscopic retrograde cholangiopancreatography (ERCP) during 1965-2009 in the Swedish Hospital Discharge Registry, but without a diagnosis of malignancy in the Swedish Cancer Registry, were included. The outcome death was identified by cross-linkage to the Causes of Death Registry. Registry data on possible risk factors for mortality were collected. Results: A total of 126 885 procedures were performed in 110 119 patients. Open surgery was initially the only available method, but during the 1990s ERCP became predominant. Later, laparoscopic bile duct clearance became an established but uncommon method. A 90-day mortality rate of 0·2 per cent after open surgery, 0·8 per cent after ERCP, 0 per cent after laparoscopic exploration and 0·7 per cent after combined procedures was recorded. After adjustment for confounding, there was no difference in mortality between open surgery and ERCP. Biliary reintervention within 90 days was identified as a risk factor for death, whereas a concomitant diagnosis of pancreatitis reduced the risk. Conclusion: The laparoscopic technique had the lowest mortality and morbidity rates. After adjustment for confounding factors, there was no difference in mortality after open surgery and ERCP. The favourable outcome for laparoscopy may have been due to selection bias, owing to treatment of younger, healthier subjects with less severe disease. [ABSTRACT FROM AUTHOR]

Background: Incidence-based mortality modelling comparing the risk of breast cancer death in screened and unscreened women in nine Swedish counties has suggested a 39% risk reduction in women 40 to 69 years old after introduction of mammography screening in the 1980s and 1990s. Objective: We evaluated changes in breast cancer mortality in the same nine Swedish counties using a model approach based on official Swedish breast cancer mortality statistics, robust to effects of over-diagnosis and treatment changes. Using mortality data from the Nord Can database from 1974 until 2003, we estimated the change in breast cancer mortality before and after introduction of mammography screening in at least the 13 years that followed screening start. Results: Breast mortality decreased by 16% (95% CI: 9 to 22%) in women 40 to 69, and by 11% (95% CI: 2 to 20%) in women 40 to 79 years of age. Discussion: Without individual data it is impossible to completely separate the effects of improved treatment and health service organisation from that of screening, which would bias our results in favour of screening. There will also be some contamination of post-screening mortality from breast cancer diagnosed prior to screening, beyond our attempts to adjust for delayed benefit. This would bias against screening. However, our estimates from publicly available data suggest considerably lower benefits than estimates based on comparison of screened versus non-screened women. [ABSTRACT FROM AUTHOR]

Objective: To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England. Methods: All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18-C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up. Results: The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis. Conclusions: There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden. [ABSTRACT FROM AUTHOR]

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Objective To assess whether higher mortality rates among individuals in motor vehicle crashes in areas with low population density depend on injury type and severity or are related to the performance of emergency medical services (EMS). Methods Prehospital and hospital deaths were studied in a population-based cohort of 41 243 motor vehicle crashes that occurred in Sweden between 1998 and 2004. The final multivariable analysis was restricted to 6884 individuals in motor vehicle crashes, to minimise the effects of confounding factors. Results Crude mortality rates following motor vehicle crashes were inversely related to regional population density. In regions with low population density, the unadjusted rate ratio for prehospital death was 2.2 (95% CI 1.9 to 2.5) and for hospital death 1.5 (95% CI 1.1 to 1.9), compared with a high-density population. However, after controlling for regional differences in age, gender and the type/severity of injuries among 6884 individuals in motor vehicle crashes, low population density was no longer associated with increased mortality. At 25 years of age, predicted prehospital mortality was 9% lower (95% CI 5% to 12%) in regions with low population density compared with high population density. This difference decreased with increasing age, but was still 3% lower (95% CI 0.5% to 5%) at 65 years of age. Conclusions The inverse relationship between population density and mortality among individuals in motor vehicle crashes is related to pre-crash factors that influence the type and severity of injuries and not to differences in EMS. [ABSTRACT FROM PUBLISHER]

Although mortality in older ages generally declined in most countries during the past decades less is known about mortality trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between 1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions. Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk among men with complex health problems has implications for the individual who may face longer periods of complex health problems and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers. [ABSTRACT FROM AUTHOR]

This study provides a comparative time-trend evaluation of injury mortality in local communities in Sweden and the three Baltic States, considering their national socio-political and economic situations and with analysis of local injury prevention structures and activities. Data for the period from 1990 to 2002 were gathered from national statistical offices for the cities of Borås, Tartu, Jelgava and Kaunas and from WHO databases for national level analyses. The death rates for Borås remained relatively stable over the time period, while the Baltic communities had increasing rates until 1994 and seemed to stabilize after 1997. The differences in injury mortality in the studied communities were highest for the 0 - 19 year age group and especially in the 20 - 64 year age group, but not for the 65+ year age group. Local communities in the Baltic States should consider coordinated safety promotion and injury prevention programmes as a complement to national safety promotion framework. [ABSTRACT FROM AUTHOR]

Background : This follow‐up study analyses whether there is an association between income distribution in Swedish municipalities and risk of death from all causes in the total Swedish population aged 40–64 years and compares the results obtained with analyses performed on individual‐level analysis and multilevel analysis. Methods : Individual‐level data on social and economic circumstances were obtained from various official records and were linked to the national cause‐of‐death register. Analyses were made with two methods, an individual‐level regression and a multilevel regression. The study population comprised all people 40–64 years of age in the 1990 Swedish census, altogether 2.57 million people in 284 municipalities. Results : The main results showed that in the individual‐level regression the income distribution showed a positive and significant association (risk ratio = 1.29; 95% CI = 1.24–1.34) with higher mortality for those living in municipalities with higher income inequality. This association was not found in the multilevel regression analysis (RR = 1.03; 95%CI = 0.94–1.13). Conclusion : There seems to be no association between income distribution and mortality in Sweden when considering the possibility of clustering in municipalities. Further studies on the relationship between income inequality and health should aim at elucidate processes within area‐level units. [ABSTRACT FROM AUTHOR]

Background: Several studies have shown a markedly higher mortality rate among disability pensioners than among non-retired. Since most disability pensions are granted because of non-fatal diseases the reason for the increased mortality therefore remains largely unknown. The aim of this study was to evaluate potential explanatory factors. Methods: Data from five longitudinal cohort studies in Sweden, including 6,887 men and women less than 65 years old at baseline were linked to disability pension data, hospital admission data, and mortality data from 1971 until 2001. Mortality odds ratios were analyzed with Poisson regression and Cox's proportional hazards regression models. Results: 1,683 (24.4%) subjects had a disability pension at baseline or received one during follow up. 525 (7.6%) subjects died during follow up. The subjects on disability pension had a higher mortality rate than the non-retired, the hazards ratio (HR) being 2.78 (95%CI 2.08-3.71) among women and 3.43 (95%CI 2.61-4.51) among men. HR was highest among individuals granted a disability pension at young ages (HR > 7), and declined parallel to age at which the disability pension was granted. The higher mortality rate among the retired subjects was not explained by disability pension cause or underlying disease or differences in age, marital status, educational level, smoking habits or drug abuse. There was no significant association between reason for disability pension and cause of death. Conclusion: Subjects with a disability pension had increased mortality rates as compared with non-retired subjects, only modestly affected by adjustments for psycho-socio-economic factors, underlying disease, etcetera. It is unlikely that these factors were the causes of the unfavorable outcome. Other factors must be at work. [ABSTRACT FROM AUTHOR]

The second half of the twentieth century witnessed substantial convergence in life expectancy around the world. We examine differences in the age pattern of mortality in industrialized countries over time to show that inequality in adult life spans, which we measure with the standard deviation of life table ages at death above age 10 years, S10, is increasingly responsible for the remaining divergence in mortality. We report striking differences in level and trend of S10 across industrialized countries since 1960, which cannot be explained by aggregate socioeconomic inequality or differential external-cause mortality. Rather, S10 reflects both within- and between-group inequalities in life spans and conveys new information about their combined magnitudes and trends. These findings suggest that the challenge for health policies in this century is to reduce inequality, not just lengthen life. [ABSTRACT FROM AUTHOR]

The article presents a critique to the article "The Swedish Myth: The Corporal Punishment Ban and Child Death Statistics," by Chris Beckett published in an earlier issue of the journal. Chris Beckett has discussed the corporal punishment ban and child death statistics in Sweden. The author says that Beckett's main objective was to prove that there is no close connection between legal banning of child abuse and a decreasing frequency of child homicides. According to the author, the title of the article is misleading. The figures from the United Nation Children's Fund are from one single year and just a few more deaths in small countries like the Scandinavian countries could alter the figures quite substantially. The author was quite astonished when he first saw the figures, as the lowest figures were reported from countries where awareness and debate concerning child maltreatment have come into focus late, particularly in comparison with Great Britain and the Scandinavian countries. The author feels that it is very important to clarify the reasons behind child homicides in order to institute appropriate preventive measures.

We extend Nathan Keyfitz's research on continuous change in life expectancy over time by presenting and proving a new formula for decomposing such change. The formula separates change in life expectancy over time into two terms. The first term captures the general effect of reduction in death rates at all ages, and the second term captures the effect of heterogeneity in the pace of improvement in mortality at different ages. We extend the formula to decompose change in life expectancy into age-specific and cause-specific components, and apply the methods to analyze changes in life expectancy in Sweden and Japan. [ABSTRACT FROM AUTHOR]

Rectangularization of human survival curves is associated with decreasing variability in the distribution of ages at death. This variability, as measured by the interquartile range of life table ages at death, has decreased from about 65 years to 15 years since 1751 in Sweden. Most of this decline occurred between the 1870s and the 1950s. Since then, variability in age at death has been nearly constant in Sweden, Japan, and the United States, defying predictions of a continuing rectangularization. The United States is characterized by a relatively high degree of variability, compared with both Sweden and Japan. We suggest that the historical compression of mortality may have had significant psychological and behavioral impacts. [ABSTRACT FROM AUTHOR]

This study concerns the relation between mortality and the short-term outcome of inpatient treatment for alcoholism. A total of 121 patients (87 men, 34 women) were included, of whom 89 were voluntary and 32 compulsorily committed. They had a mean age of 41±7 (SD) years and attended a 5-week programme at Runnagården, Örebro, Sweden. Most patients were socially unstable and severely alcohol-dependent. Ten months (mean) after discharge, 96% of the patients and their referring social workers were contacted with mail questionnaires. Of these patients, 13% had been totally abstinent and a further 42% improved but had had relapses. After a mean of 8.5±0.27 years, 27 patients (24%) had died. All abstainers survived, but non-abstainers had nine-fold higher mortality than expected. Non-abstinent improved women tended to survive longer than non-improved women, but among non-abstinent improved men no such tendency was found. In conclusion, a reduction in the frequency and quantity of abusive drinking was not enough to reduce the higher risk of death. Only abstinence seemed to be preventive. [ABSTRACT FROM PUBLISHER]

This study summarizes differences between Sweden and the United States regarding certain aspects of infant mortality. Sweden has the lowest infant mortality rate (IMR) and the United States is number 16. Both the neonatal and postneonatal mortality rates of Sweden are considerably lower. Since 1960, the neonatal mortality rate of Sweden was reduced by a greater percentage. The incidence of low birth weight in Sweden is considerably lower. In the United States, no state has an IMR as low as that of Sweden. Nonwhite babies, babies born out of wedlock, and those of teenage or ‘old’ mothers have a higher IMR. The article describes in some detail the organization and network of services in Sweden that may be playing an important role in Sweden's low IMR. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the effect of cumulative exposure to work organization-psychological demands, work control, and social support-on prospectively measured cardiovascular disease mortality risk. Methods. The source population was a national sample of 12517 subjects selected from the Swedish male population by Statistics Sweden in annual surveys between 1977 and 1981. Over a 14-year follow-up period, 521 deaths from cardiovascular disease were identified. A nested case-control design was used. Work environment exposure scores were assigned to cases and controls by linking lifetime job histories with a job exposure matrix. Results. Conditional logistic regression analysis was used in examining cardiovascular mortality risk in relation to work exposure after adjustment for age, year last employed, smoking, exercise, education, social class, nationality, and physical job demands. In the final multi-variable analysis, workers with low work control had a relative risk of 1.83 (95% confidence interval [CI] = 1.19,2.82) for: cardiovascular mortality. Workers with combined exposure to low control and low support had a relative risk of 2.62 (95% CI = 122, 5.61). Conclusions. These results indicate that long-term exposure to low work control is a risk factor for cardiovascular disease mortality. [ABSTRACT FROM AUTHOR]

A study was carried out to determine whether the preexisting decline in mortality rates from infectious diseases accelerated after the introduction of antibiotic and chemotherapeutic drugs?Linear regression curves showed that in Sweden mortality rates declined faster in septicemia syphilis, and non-meningococcal meningitis after the introduction of these drugs. By contrast, for the ten other infectious diseases studied, (scarlet fever, erysipelas, acute rheumatic fevers, puerperal sepsis, meningococcal infection, bronchitis, pneumonia, tuberculosis typhoid fever, and acute gastroenteritis) no such accelerated decline in mortality could be detected. The findings suggest that antibiotic and chemotherapeutic drugs have not had the dramatic effect on she mortality of infectious diseases popularly attributed to them. [ABSTRACT FROM AUTHOR]

The life expectancy of males in the United States is lower than that of males in most of the developed countries and in some of the not-so-developed ones. U.S. females, by contrast, do much better in international ranking. This study compares the mortality of U.S. white males with that of Swedish males who have had the highest reported male life expectancies in the world since the early 1960s. Life expectancy at birth in 1969-71 was 67.9 for U.S. white males compared with 71.9 for Swedish males. Greater U.S. white male mortality is found at all ages from birth through ages 75-79. At the tipper ages there is a reversal of the differential with U.S. white males having lower mortality than their Swedish counterparts. The greatest relative differentials between the two mate populations is found at ages under 1, ages 20-24, and ages 50-59. At ages under 1 the greater U.S. white male mortality is accounted for mainly by higher death rates from infectious diseases, at ages 20-24 by higher rates from the external causes of death (specifically accidents and homicide), and at ages 50-59 from most of the major organic causes of death. [ABSTRACT FROM AUTHOR]

Data from Hungary and Sweden are used to investigate the extent to which prematurity confounds the relationship between length of preceding birth interval and perinatal mortality. Controlling for length of gestation removes between 65 and 90 per cent of the excess mortality associated with birth intervals of less than 18 months; however, mortality among infants who are born less than 18 months after the birth of their previous sibling is still higher than among infants born after longer intervals. These results suggest that, although short birth intervals are associated with high perinatal mortality, estimates of the risks attributable to birth-spacing are overstated, if length of gestation is not taken into account. [ABSTRACT FROM AUTHOR]

Background Classification of injuries and estimation of injury severity on the basis of ICD-10 injury coding are powerful epidemiological tools. Little is known about the characteristics and consequences of primary coding errors and their consequences for such applications. Materials and methods From the Swedish national hospital discharge register, 15 899 incident injury cases primarily admitted to the two hospitals in Uppsala County between 2000 and 2004 were identified. Of these, 967 randomly selected patient records were reviewed. Errors in injury diagnosis were corrected, and the consequences of these changes were analysed. Results Out of 1370 injury codes, 10% were corrected, but 95% of the injury codes were correct to the third position. In 21% (95% CI 19% to 24%) of 967 hospital admissions, at least one ICD-10 code for injury was changed or added, but only 13% (127) had some change made to their injury mortality diagnosis matrix classification. Among the cases with coding errors, the mean ICD-based injury severity score changed slightly (difference 0.016; 95% CI 0.007 to 0.032). The area under the receiver operating characteristics curve was 0.892 for predicting hospital mortality and remained essentially unchanged after the correction of codes (95% CI for difference -0.022 to 0.013). Conclusion Errors in ICD-10-coded injuries in hospital discharge data were common, but the consequences for injury categorisation were moderate and the consequences for injury severity estimates were in most cases minor. The error rate for detailed levels of cause-of-injury codes was high and may be detrimental for identifying specific targets for prevention. [ABSTRACT FROM AUTHOR]