#Social #distancing laws cause only small #losses of #economic #activity during the #COVID19 pandemic in #Scandinavia (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Social distancing laws cause only small losses of economic activity during the COVID-19 pandemic in Scandinavia

Adam Sheridan,  Asger Lau Andersen,  Emil Toft Hansen, and Niels Johannesen

PNAS first published August 3, 2020 https://doi.org/10.1073/pnas.2010068117

Edited by Jose A. Scheinkman, Columbia University, New York, NY, and approved July 16, 2020 (received for review May 19, 2020)

 

Significance

Social distancing laws that restrict the activities of private businesses are often seen as sacrificing the economy to save lives from COVID-19. Indeed, many countries have experienced massive reductions in consumer spending around the time they began to shut down. We show that these restrictions are, in fact, responsible for only a small portion of the drop in consumer spending. This suggests that the virus itself is responsible for the majority of the economic damage. We find that social distancing laws may provide an economic benefit: the laws reduce the economic activity of the low-risk population and can thus protect those with the greatest risk of mortality from also bearing the greatest burden in terms of reduced spending.

 

Abstract

This paper uses real-time transaction data from a large bank in Scandinavia to estimate the effect of social distancing laws on consumer spending in the coronavirus 2019 (COVID-19) pandemic. The analysis exploits a natural experiment to disentangle the effects of the virus and the laws aiming to contain it: Denmark and Sweden were similarly exposed to the pandemic but only Denmark imposed significant restrictions on social and economic activities. We estimate that aggregate spending dropped by around 25% (95% CI: 24 to 26%) in Sweden and, as a result of the shutdown, by 4 additional percentage points (95% CI: 3 to 5 percentage points [p.p.]) in Denmark. This suggests that most of the economic contraction is caused by the virus itself and occurs regardless of social distancing laws. The age gradient in the estimates suggests that social distancing reinforces the virus-induced drop in spending for low-health-risk individuals but attenuates it for high-risk individuals by lowering the overall prevalence of the virus in the society.

COVID-19 – consumer spending – social distancing – shutdown

 

Footnotes

1 To whom correspondence may be addressed. Email: adam.sheridan@econ.ku.dk.

Author contributions: A.S., A.L.A., E.T.H., and N.J. designed research; A.S., A.L.A., E.T.H., and N.J. performed research; A.S. and E.T.H. analyzed data; and A.S., A.L.A., E.T.H., and N.J. wrote the paper.

The authors declare no competing interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2010068117/-/DCSupplemental.
Published under the PNAS license.

Keywords: SARS-CoV-2; COVID-19; Quarantine; Denmark; Sweden; Society.

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Relationship between #odor #intensity estimates and #COVID19 #prevalence prediction in a #Swedish population (Chem Senses, abstract)

[Source: Chemical Senses, full page: (LINK). Abstract, edited.]

Relationship between odor intensity estimates and COVID-19 prevalence prediction in a Swedish population

Behzad Iravani, Artin Arshamian, Aharon Ravia, Eva Mishor, Kobi Snitz, Sagit  Shushan,  Yehudah Roth, Ofer Perl, Danielle Honigstein, Reut Weissgross, Shiri Karagach, Gernot  Ernst, Masako Okamoto, Zachary Mainen, Erminio Monteleone, Caterina Dinnella, Sara  Spinelli, Franklin Mariño-Sánchez, Camille Ferdenzi, Monique Smeets, Kazushige  Touhara, Moustafa Bensafi, Thomas Hummel, Noam Sobel, Johan N Lundström

Chemical Senses, bjaa034, https://doi.org/10.1093/chemse/bjaa034

Published: 22 May 2020

 

Abstract

In response to the COVID-19 pandemic, countries have implemented various strategies to reduce and slow the spread of the disease in the general population. For countries that have implemented restrictions on its population in a step-wise manner, monitoring of COVID-19 prevalence is of importance to guide decision on when to impose new, or when to abolish old, restrictions. We are here determining whether measures of odor intensity in a large sample can serve as one such measure. Online measures of how intense common household odors are perceived and symptoms of COVID-19 were collected from 2440 Swedes. Average odor intensity ratings were then compared to predicted COVID-19 population prevalence over time in the Swedish population and were found to closely track each other (r=-0.83). Moreover, we found that there was a large difference in rated intensity between individuals with and without COVID-19 symptoms and number of symptoms was related to odor intensity ratings. Finally, we found that individuals progressing from reporting no symptoms to subsequently reporting COVID-19 symptoms demonstrated a large drop in olfactory performance. These data suggest that measures of odor intensity, if obtained in a large and representative sample, can be used as an indicator of COVID-19 disease in the general population. Importantly, this simple measure could easily be implemented in countries without widespread access to COVID-19 testing or implemented as a fast early response before wide-spread testing can be facilitated.

Coronavirus, anosmia, olfactory dysfunction, COVID-19, population prevalence

Issue Section: Original Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: SARS-CoV-2; COVID-19; Anosmia; Sweden.

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#Sindbis virus #polyarthritis #outbreak signalled by virus prevalence in the #mosquito vectors (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Sindbis virus polyarthritis outbreak signalled by virus prevalence in the mosquito vectors

Jan O. Lundström , Jenny C. Hesson, Martina L. Schäfer, Örjan Östman, Torsten Semmler, Michaël Bekaert, Manfred Weidmann, Åke Lundkvist, Martin Pfeffer

Published: August 29, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007702 / This is an uncorrected proof.

 

Abstract

Polyarthritis and rash caused by Sindbis virus (SINV), was first recognised in northern Europe about 50 years ago and is known as Ockelbo disease in Sweden and Pogosta disease in Finland. This mosquito-borne virus occurs mainly in tropical and sub-tropical countries, and in northern Europe it is suggested to cause regularly reoccurring outbreaks. Here a seven-year cycle of SINV outbreaks has been referred to in scientific papers, although the hypothesis is based solely on reported human cases. In the search for a more objective outbreak signal, we evaluated mosquito abundance and SINV prevalence in vector mosquitoes from an endemic area in central Sweden. Vector mosquitoes collected in the River Dalälven floodplains during the years before, during, and after the hypothesised 2002 outbreak year were assayed for virus on cell culture. Obtained isolates were partially sequenced, and the nucleotide sequences analysed using Bayesian maximum clade credibility and median joining network analysis. Only one SINV strain was recovered in 2001, and 4 strains in 2003, while 15 strains were recovered in 2002 with significantly increased infection rates in both the enzootic and the bridge-vectors. In 2002, the Maximum Likelihood Estimated infection rates were 10.0/1000 in the enzootic vectors Culex torrentium/pipiens, and 0.62/1000 in the bridge-vector Aedes cinereus, compared to 4.9/1000 and 0.0/1000 in 2001 and 0.0/1000 and 0.32/1000 in 2003 Sequence analysis showed that all isolates belonged to the SINV genotype I (SINV-I). The genetic analysis revealed local maintenance of four SINV-I clades in the River Dalälven floodplains over the years. Our findings suggest that increased SINV-I prevalence in vector mosquitoes constitutes the most valuable outbreak marker for further scrutinising the hypothesized seven-year cycle of SINV-I outbreaks and the mechanisms behind.

 

Author summary

The mosquito-borne Sindbis virus (SINV) causes polyarthritis and rash known as Ockelbo disease in Sweden and Pogosta disease in Finland. This mainly tropical and sub-tropical virus occurs in many countries, and in northern Europe it is suggested to cause reoccurring outbreaks every seventh year. The seven-year SIN outbreak cycle is commonly referred to in scientific papers, although the hypothesis is based solely on reported clinical cases. In the search for a more objective outbreak risk signal, we evaluated abundance and SINV prevalence in vector mosquitoes from Sweden. Vector mosquitoes collected in the River Dalälven floodplains the years before, during and after the hypothesized 2002 outbreak, were assayed for SINV. SINV prevalence was significantly increased in vector mosquitoes during the hypothesized 2002 outbreak, as compared to the 2001 pre-outbreak and the 2003 post-outbreak years. Genetic analysis showed a close relationship between the virus strains, indicating SINV has remained in local annual enzootic circulation since been introduced into the River Dalälven floodplains. We conclude that increased SINV prevalence in vector mosquitoes constitutes a marker most valuable for studying the seven-year outbreak cycle.

___

Citation: Lundström JO, Hesson JC, Schäfer ML, Östman Ö, Semmler T, Bekaert M, et al. (2019) Sindbis virus polyarthritis outbreak signalled by virus prevalence in the mosquito vectors. PLoS Negl Trop Dis 13(8): e0007702. https://doi.org/10.1371/journal.pntd.0007702

Editor: Jason L. Rasgon, The Pennsylvania State University, UNITED STATES

Received: August 29, 2018; Accepted: August 13, 2019; Published: August 29, 2019

Copyright: © 2019 Lundström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Arbovirus; Sindbis virus; Polyarthritis; Sweden; Finland; Mosquitoes.

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Linked seasonal #outbreaks of #Salmonella Typhimurium among #passerine #birds, domestic #cats and #humans, #Sweden, 2009 to 2016 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Linked seasonal outbreaks of Salmonella Typhimurium among passerine birds, domestic cats and humans, Sweden, 2009 to 2016

Robert Söderlund 1, Cecilia Jernberg 2, Linda Trönnberg 2, Anna Pääjärvi 2, Erik Ågren 1, Elina Lahti 1

Affiliations: 1 National Veterinary Institute, Uppsala, Sweden; 2 Public Health Agency of Sweden, Solna, Sweden

Correspondence:  Robert Söderlund

Citation style for this article: Söderlund Robert, Jernberg Cecilia, Trönnberg Linda, Pääjärvi Anna, Ågren Erik, Lahti Elina. Linked seasonal outbreaks of Salmonella Typhimurium among passerine birds, domestic cats and humans, Sweden, 2009 to 2016. Euro Surveill. 2019;24(34):pii=1900074. https://doi.org/10.2807/1560-7917.ES.2019.24.34.1900074

Received: 24 Jan 2019;   Accepted: 29 Apr 2019

 

Abstract

In 2016, an outbreak of Salmonella Typhimurium (STm) with multilocus variable-number tandem repeat analysis (MLVA) profiles historically associated with passerine birds (2-[11-15]-[3-4]-NA-212) occurred among passerines, cats and humans in Sweden. Our retrospective observational study investigated the outbreak and revisited historical data from 2009–16 to identify seasonality, phylogeography and other characteristics of this STm variant. Outbreak isolates were analysed by whole-genome single nucleotide polymorphism (SNP) typing. The number of notified cases of passerine-associated STm among passerines, cats and humans per month and county, and their MLVA profiles, were compared to birdwatchers’ counts of passerines. Seasonal trend decomposition and correlation analysis was performed. Outbreak isolates did not cluster by host on SNP level. Passerine-associated STm was seasonal for birds, cats and humans, with a peak in March. Cases and counts of passerines at bird feeders varied between years. The incidence of passerine-associated STm infections in humans was higher in the boreal north compared with the southern and capital regions, consistent with passerine population densities. Seasonal mass migration of passerines appears to cause STm outbreaks among cats certain years in Sweden, most likely via predation on weakened birds. Outbreaks among humans can follow, presumably caused by contact with cats or environmental contamination.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Wild Birds; Salmonellosis; Cats; Human; Sweden.

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The Long-Lasting #Influenza: The #Impact of #Fetal #Stress During the 1918 Influenza #Pandemic on #Socioeconomic Attainment and Health in #Sweden, 1968-2012 (Demography, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Demography. 2019 Jul 19. doi: 10.1007/s13524-019-00799-x. [Epub ahead of print]

The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968-2012.

Helgertz J1,2, Bengtsson T3,4,5.

Author information: 1 Centre for Economic Demography (CED) and Department of Economic History, Lund University, Box 7083, 220 07, Lund, Sweden. Jonas.Helgertz@ekh.lu.se. 2 Minnesota Population Center, University of Minnesota, 50 Willey Hall, 225 19th Avenue South, Minneapolis, MN, 55455, USA. Jonas.Helgertz@ekh.lu.se. 3 Centre for Economic Demography (CED) and Department of Economic History, Lund University, Box 7083, 220 07, Lund, Sweden. 4 IZA, Institute of Labor Economics, Schaumburg-Lippe-Strasse 5-9, 53113, Bonn, Germany. 5 CEPR, Centre for Economic Policy Research, 33 Great Sutton Street, London, EC1V 0DX, UK.

 

Abstract

The 1918 influenza pandemic had not only a massive instant death toll but also lasting effects on its survivors. Several studies have shown that children born in 1919, and thus exposed to the H1N1 virus in utero, experienced worse health and socioeconomic outcomes in older ages than surrounding birth cohorts. This study combines several sources of contemporary statistics with full-population individual-level data for Sweden during 1968-2012 to examine the influence of fetal exposure to the Spanish flu on health, adulthood income, and occupational attainment. For both men and women, fetal exposure resulted in higher morbidity in ages 54-87, as measured by hospitalization. For males, exposure during the second trimester also affected mortality in cancer and heart disease. Overall, the effects on all-cause mortality were modest, with about three months shorter remaining life expectancy for the cohorts exposed during the second trimester. For socioeconomic outcomes, results fail to provide consistent evidence supporting any long-term consequences of fetal exposure. We conclude that although the immediate health effects of exposure to the 1918 pandemic were huge, the long-term effects were modest in size.

KEYWORDS: Fetal origins; Health and socioeconomic outcomes; Longitudinal data; Spanish influenza pandemic; Sweden

PMID: 31325150 DOI: 10.1007/s13524-019-00799-x

Keywords: Pandemic Influenza; Spanish Flu; Sweden; Society.

——

The #effect of a #terrorist #attack on #emergency department inflow: an observation study using difference-in-differences methodology (Scand J Trauma Resusc & Emerg Med., abstract)

[Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, full page: (LINK). Abstract, edited.]

Original research / Open Access

The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology

Andreas Ekström, Fredrik Eng-Larsson, Olov Isaksson, Lisa Kurland and Martin Nordberg

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 201927:57
/ DOI: https://doi.org/10.1186/s13049-019-0634-2

©  The Author(s). 2019

Received: 5 March 2019 – Accepted: 17 May 2019 – Published: 24 May 2019

 

Abstract

Study objective

The objective of this study was to investigate how the terrorist attack in Stockholm, Sweden affected patient inflow to the general emergency departments (EDs) in close proximity of the attack. The study analyzed if, and to what extent, the attack impacted ED inflow during the following days and weeks.

Methods

In a retrospective observational study, anonymized aggregated data on ED arrivals (inflow of patients) to all seven of the EDs in the Stockholm County was analyzed using the Difference-in-Differences (DiD) estimator. The control groups were the affected hospitals in the years prior to the terrorist attack. The number of ED visits was retrieved from the Stockholm County Council administrative database.

Results

The study shows a statistically significant reduction in overall ED inflow of 7–9% following the attack. The effect was strongest initially after the attack, and ED inflow regained normal levels within approximately three weeks’ time, without any significant rebound effect. The effect on ED inflow also decreased with distance from ground zero, and was not significant further away than 10 km.

Conclusion

The results showed that ED inflow was significantly decreased in the weeks immediately following the Stockholm terrorist attack. The reasons for this cannot be fully explained in this observational study. However, the results suggest that some patients actively choose when, where and if they should go to the ED.

Keywords: Emergency service – Hospital – Patient acceptance of health care – Terrorism – Health behavior

Keywords: Terrorism; Society; Sweden.

——

Change in #risk for #narcolepsy over time and impact of definition of onset date following #vaccination with #AS03 adjuvanted pandemic A/H1N1 influenza vaccine (#Pandemrix) during the 2009 H1N1 influenza #pandemic (Pharmacoepidemiol Drug Saf., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pharmacoepidemiol Drug Saf. 2019 May 6. doi: 10.1002/pds.4788. [Epub ahead of print]

Change in risk for narcolepsy over time and impact of definition of onset date following vaccination with AS03 adjuvanted pandemic A/H1N1 influenza vaccine (Pandemrix) during the 2009 H1N1 influenza pandemic.

Granath F1, Gedeborg R2, Smedje H3, Feltelius N4.

Author information: 1 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden. 2 Department of Efficacy and Safety 1, Medical Products Agency, Uppsala, Sweden. 3 Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden. 4 Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden.

 

Abstract

PURPOSE:

To estimate risk for narcolepsy in defined time windows following exposure to adjuvanted A(H1N1) pandemic vaccine (Pandemrix) and impact of different definitions of index date for the narcolepsy diagnosis.

METHODS:

Vaccine exposure in approximately 30% of the Swedish population in 2009 was linked to information on narcolepsy diagnosis retrieved from the national patient registry. Cases were verified by a systematic chart review. Poisson regression was used to compare incidence in defined time windows following vaccination.

RESULTS:

Of 266 cases of narcolepsy identified, 25% (66/266) were prevalent cases with symptom onset documented before vaccine exposure. Incident cases had a median time interval between first symptom and the date recorded in the patient registry of 64 weeks (IQR 39-107) when vaccinated (N = 182) and 65 weeks (IQR 51-72) when unvaccinated (N = 16). With first symptom defining index date, the adjusted risk for narcolepsy in younger patients was increased 14 times during the first year after vaccination, three times elevated the second year, but with no detectable increased risk more than 2 years after vaccination exposure. Using the index date from the patient registry, the adjusted increase in risk was about seven times elevated for all three time intervals.

CONCLUSIONS:

The magnitude of the estimated increased risk for narcolepsy following exposure to the A(H1N1) pandemic vaccine is highly dependent on the method used to determine the index date for disease onset. The sometimes very long and potentially variable interval from first symptom to a health care registry diagnosis complicates estimations of risk.

© 2019 John Wiley & Sons, Ltd.

KEYWORDS: H1N1 subtype; adverse effects; influenza A virus; mass vaccination; narcolepsy; pandemics; pharmacoepidemiology; vaccination

PMID: 31062443 DOI: 10.1002/pds.4788

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Narcolepsy; Sweden.

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Novel #influenza A(#H1N2) seasonal #reassortant identified in a patient sample, #Sweden, January 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Novel influenza A(H1N2) seasonal reassortant identified in a patient sample, Sweden, January 2019

Åsa Wiman1,2, Theresa Enkirch1,2, AnnaSara Carnahan3, Blenda Böttiger4, Tove Samuelsson Hagey1, Per Hagstam5, Rosmarie Fält5, Mia Brytting1

Affiliations: 1 Unit for Laboratory Surveillance of Viral Pathogens and Vaccine Preventable Diseases, Department of Microbiology, the Public Health Agency of Sweden, Solna, Sweden; 2 Authors contributed equally to the work and share first authorship; 3 Unit for Vaccination Programmes, Department of Communicable Disease Control and Health Protection, the Public Health Agency of Sweden, Solna, Sweden; 4 Clinical Microbiology Laboratory, Lund, Sweden; 5 Regional Office of Communicable Disease Control and Prevention, Region Skåne, Malmö, Sweden

Correspondence:  Theresa Enkirch

Citation style for this article: Wiman Åsa, Enkirch Theresa, Carnahan AnnaSara, Böttiger Blenda, Hagey Tove Samuelsson, Hagstam Per, Fält Rosmarie, Brytting Mia. Novel influenza A(H1N2) seasonal reassortant identified in a patient sample, Sweden, January 2019. Euro Surveill. 2019;24(9):pii=1900124. https://doi.org/10.2807/1560-7917.ES.2019.24.9.1900124

Received: 15 Feb 2019;   Accepted: 25 Feb 2019

 

Abstract

In January 2019, a human seasonal reassortant influenza A(H1N2) virus with a novel 7:1 genetic constellation was identified in a 68-year-old female patient with suspected pneumonia. The virus harboured A(H3N2) neuraminidase and remaining genes from A(H1N1)pdm09. The patient recovered after severe illness. No additional cases have been detected. This is the second identified A(H1N2) seasonal reassortant in a human in Europe within 1 year; a previous case was detected in the Netherlands in March 2018.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; H1N1pdm09; H3N2; H1N2; Reassortant strain; SARI; Sweden.

——

#Socioeconomic #disparities associated with 29 common #infectious #diseases in #Sweden, 2005–14: an individually matched case-control study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Socioeconomic disparities associated with 29 common infectious diseases in Sweden, 2005–14: an individually matched case-control study

Alessandro Pini, MD, Magnus Stenbeck, PhD, Ilias Galanis, MSc, Henrik Kallberg, PhD, Kostas Danis, PhD, Anders Tegnell, MD, Anders Wallensten, MD

Published: December 14, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30485-7

 

Summary

Background

Although the association between low socioeconomic status and non-communicable diseases is well established, the effect of socioeconomic factors on many infectious diseases is less clear, particularly in high-income countries. We examined the associations between socioeconomic characteristics and 29 infections in Sweden.

Methods

We did an individually matched case-control study in Sweden. We defined a case as a person aged 18–65 years who was notified with one of 29 infections between 2005 and 2014, in Sweden. Cases were individually matched with respect to sex, age, and county of residence with five randomly selected controls. We extracted the data on the 29 infectious diseases from the electronic national register of notified infections and infectious diseases (SmiNet). We extracted information on country of birth, educational and employment status, and income of cases and controls from Statistics Sweden’s population registers. We calculated adjusted matched odds ratios (amOR) using conditional logistic regression to examine the association between infections or groups of infections and place of birth, education, employment, and income.

Findings

We included 173 729 cases notified between Jan 1, 2005, and Dec 31, 2014 and 868 645 controls. Patients with invasive bacterial diseases, blood-borne infectious diseases, tuberculosis, and antibiotic-resistant infections were more likely to be unemployed (amOR 1·59, 95% CI 1·49–1·70; amOR 3·62, 3·48–3·76; amOR 1·88, 1·65–2·14; and amOR 1·73, 1·67–1·79, respectively), to have a lower educational attainment (amOR 1·24, 1·15–1·34; amOR 3·63, 3·45–3·81; amOR 2·14, 1·85–2·47; and amOR 1·07, 1·03–1·12, respectively), and to have a lowest income (amOR 1·52, 1·39–1·66; amOR 3·64, 3·41–3·89; amOR 3·17, 2·49–4·04; and amOR 1·2, 1·14–1·25, respectively). By contrast, patients with food-borne and water-borne infections were less likely than controls to be unemployed (amOR 0·74, 95% CI 0·72–0·76), to have lower education (amOR 0·75, 0·73–0·77), and lowest income (amOR 0·59, 0·58–0·61).

Interpretation

These findings indicate persistent socioeconomic inequalities in infectious diseases in an egalitarian high-income country with universal health care. We recommend using these findings to identify priority interventions and as a baseline to monitor programmes addressing socioeconomic inequalities in health.

Funding

The Public Health Agency of Sweden.

Keywords: Society; Public Health; Sweden; Poverty.

——

#Child #mortality in #England compared with #Sweden: a birth cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Child mortality in England compared with Sweden: a birth cohort study

Ania Zylbersztejn, MD, Ruth Gilbert, MD, Anders Hjern, MD, Linda Wijlaars, PhD, Pia Hardelid, PhD

Published: 03 May 2018 / Open Access  / DOI: https://doi.org/10.1016/S0140-6736(18)30670-6

© 2018 The Author(s). Published by Elsevier Ltd.

 

Summary

Background

Child mortality is almost twice as high in England compared with Sweden. We aimed to establish the extent to which adverse birth characteristics and socioeconomic factors explain this difference.

Methods

We developed nationally representative cohorts of singleton livebirths between Jan 1, 2003, and Dec 31, 2012, using the Hospital Episode Statistics in England, and the Swedish Medical Birth Register in Sweden, with longitudinal follow-up from linked hospital admissions and mortality records. We analysed mortality as the outcome, based on deaths from any cause at age 2–27 days, 28–364 days, and 1–4 years. We fitted Cox proportional hazard regression models to estimate the hazard ratios (HRs) for England compared with Sweden in all three age groups. The models were adjusted for birth characteristics (gestational age, birthweight, sex, and congenital anomalies), and for socioeconomic factors (maternal age and socioeconomic status).

Findings

The English cohort comprised 3 932 886 births and 11 392 deaths and the Swedish cohort comprised 1 013 360 births and 1927 deaths. The unadjusted HRs for England compared with Sweden were 1·66 (95% CI 1·53–1·81) at 2–27 days, 1·59 (1·47–1·71) at 28–364 days, and 1·27 (1·15–1·40) at 1–4 years. At 2–27 days, 77% of the excess risk of death in England was explained by birth characteristics and a further 3% by socioeconomic factors. At 28–364 days, 68% of the excess risk of death in England was explained by birth characteristics and a further 11% by socioeconomic factors. At 1–4 years, the adjusted HR did not indicate a significant difference between countries.

Interpretation

Excess child mortality in England compared with Sweden was largely explained by the unfavourable distribution of birth characteristics in England. Socioeconomic factors contributed to these differences through associations with adverse birth characteristics and increased mortality after 1 month of age. Policies to reduce child mortality in England could have most impact by reducing adverse birth characteristics through improving the health of women before and during pregnancy and reducing socioeconomic disadvantage.

Funding

The Farr Institute of Health Informatics Research (through the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and the Wellcome Trust).

Keywords: England; Sweden; Society.

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