Economic stress and low leisure-time physical activity: Two life course hypotheses

Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden

The aim was to investigate associations between marital status and mortality with a prospective cohort study design. A public health survey including adults aged 18-80 was conducted with a postal questionnaire in southern Sweden in 2008 (54.1% participation). The survey formed a baseline that was linked to 8.3-year follow-up all-cause, cardiovascular (CVD), cancer and other cause mortality. The present investigation entails 14,750 participants aged 45-80. Associations between marital status and mortality were investigated with multiple Cox-regression analyses. A 72.8% prevalence of respondents were married/cohabitating, 9.1% never married, 12.2% divorced and 5.9% widows/widowers. Marital status was associated with age, sex, socioeconomic status (SES) by occupation, country of birth, chronic disease, Body Mass Index (BMI), health-related behaviors and generalized trust covariates. Never married/single, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than the reference category married/cohabitating men throughout the multiple analyses. For men, CVD and other cause mortality showed similar significant results, but not cancer. No significant associations were displayed for women in the multiple analyses. Associations between marital status and mortality are stronger among men than women. Associations between marital status and cancer mortality are not statistically significant with low effect measures throughout the multiple analyses among both men and women.

Religious service attendance and mortality: A population-based prospective cohort study in southern Sweden

Aims

The aim is to investigate associations between attendance in religious service during the past year and all-cause, cardiovascular (CVD), cancer and other cause mortality.

Study design

Prospective cohort study.

Methods

A public health survey with three reminders was sent to a stratified random sample of the adult 18-80 population in southernmost Sweden in 2008. The response rate was 54.1%, and 24,855 participants were included in this study. The cross-sectional baseline survey was connected to mortality data with 8.3-year follow-up. Analyses were conducted in Cox regression models.

Results

13.9% had attended religious service at least once during the past year, and 86.1% had not attended. The group with religious attendance contained significantly higher proportions of women, high and medium position non-manual employees, participants born abroad, never alcohol consumers, respondents with high trust in others and respondents with high social participation. It also contained significantly lower proportions with low leisure-time physical activity (LTPA) and daily smokers. Religious service attendance during the past year was significantly associated with lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attendance until social participation items were introduced in the final model. HRRs of CVD mortality were significantly lower for religious attendance in the multiple models until BMI and health-related behaviors were introduced. No significant results were observed for cancer and other cause mortality.

Conclusions

The results suggest that religious service attendance in a highly secularized country such as Sweden is significantly associated with lower all-cause mortality, which may be explained by a social network pathway in this highly secularized population.

Trends in the rate of regular exercise among adults: results from chronic disease and risk factor surveillance from 2010 to 2018 in Jiangsu, China

Objective

The aims of this study were to estimate the rates of regular exercise and its trends among the adult population in Jiangsu, from 2010 to 2018, China, and to assess associations with sociodemographic factors.

Methods

Chronic disease and risk factor surveillance data from adults aged ≥18 years were gathered in Jiangsu Province from 2010 to 2018. Rates of regular exercise were calculated after post-stratification weighting, and time trends were compared among participants with different characteristics, including gender, age, urban-rural region, educational level, occupation, annual household income, body mass index (BMI), baseline self-reported chronic diseases, smoking status, alcohol consumption, and region. Multivariable logistic regression analyses were performed to assess the associations of sociodemographic characteristics with regular exercise.

Results

A total of 33,448 participants aged 54.05 ± 14.62 years and 55.4% female (8,374 in 2010, 8,302 in 2013, 8,372 in 2015, and 8,400 in 2018) were included in this study. The weighted rate of regular exercise was 12.28% (95% confidence interval [CI]: 9.11-15.45%) in 2010 and 21.47% (95% CI, 17.26-25.69%) in 2018, showing an overall increasing trend (P for trend = 0.009). Nevertheless, stratification analysis showed that the regular exercise rate decreased from 33.79% in 2010 to 29.78% in 2018 among retired adults. Significant associations were observed between regular exercise and age >45 years (45- < 60 years, odds ratio [OR]: 1.24, 95% CI: 1.14-1.34; ≥60 years, OR: 1.20, 95% CI: 1.08-1.34), urban residence (OR: 1.43, 95% CI: 1.32-1.54), higher education (primary, OR: 1.30, 95% CI: 1.16-1.46; secondary, OR: 2.00, 95% CI: 1.79-2.25; college or higher, OR: 3.21, 95% CI: 2.77-3.72), occupation (manual work, OR: 1.52, 95% CI: 1.33-1.73; non-manual work, OR: 1.69, 95% CI: 1.54-1.85; not working, OR: 1.22, 95% CI: 1.03-1.44; retired, OR: 2.94, 95% CI: 2.61-3.30), higher income (¥30,000- < ¥60,000, OR: 1.16, 95% CI: 1.06-1.28; ≥¥60,000, OR: 1.20, 95% CI: 1.10-1.32), higher BMI (overweight, OR: 1.12, 95% CI: 1.05-1.20), self-reported chronic disease at baseline (OR: 1.24, 95% CI:1.16-1.33), former smoking (OR: 1.15, 95% CI: 1.01-1.31) and ever (30 days ago) drinking (OR: 1.20, 95% CI: 1.11-1.29).

Conclusion

The rate of regular exercise among adults in Jiangsu Province was low, but this rate increased by 9.17% from 2010 to 2018, showing an upward trend. There were differences in the rate of regular exercise among different sociodemographic factors.

Leisure-time physical activity, desire to increase physical activity, and mortality: A population-based prospective cohort study

The aim was to investigate associations between leisure-time physical activity (LTPA) and mortality, and associations between desire to increase LTPA and mortality within the low LTPA group. A public health survey questionnaire was sent in 2008 to a stratified random sample of the population aged 18-80 in southernmost Sweden, yielding a 54.1% response rate. Baseline 2008 survey data with 25,464 respondents was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between LTPA, desire to increase LTPA and mortality were analyzed in logistic regression models. An 18.4% proportion performed regular exercise (at least 90 min/week, leading to sweating), 23.2% moderate regular exercise (once or twice a week at least 30 min/occasion, leading to sweating), 44.3% moderate exercise (more than two hours walking or equivalent activity/week) and 14.1% reported low LTPA (less than two hours walking or equivalent activity/week). These four LTPA groups were significantly associated with covariates included in the multiple analyses. The results showed significantly higher all-cause, cardiovascular (CVD), cancer and other cause mortality for the low LTPA group but not for the moderate regular exercise and moderate exercise groups compared to the regular exercise group. Both the "Yes, but I need support" and the "No" fractions within the low LTPA group had significantly increased ORs of all-cause mortality compared to the "Yes, and I can do it myself" reference, while no significant associations were observed for CVD mortality. Physical activity promotion is particularly warranted in the low LTPA group.

Health locus of control and all-cause, cardiovascular, cancer and other cause mortality: A population-based prospective cohort study in southern Sweden

The aim was to investigate associations between health locus of control (HLC) and all-cause, cardiovascular (CVD), cancer and other cause mortality. A public health postal questionnaire was distributed in the autumn of 2008 to a stratified random sample of the 18-80 year old adult population in Scania in southernmost Sweden. The participation rate was 54.1%, and 25,517 participants were included in the present study. Baseline 2008 survey data was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between health locus of control and mortality were investigated in survival (Cox) regression models. Prevalence of internal HLC was 69.0% and external HLC 31.0% among women. Internal HLC was 67.6% and external HLC 32.4% among men. In the models with women and men combined, external HLC had significantly higher all-cause, CVD, cancer and other cause mortality even after adjustments for sociodemographic factors and chronic disease at baseline, but after the introduction of health-related behaviors, external HLC only displayed higher cancer mortality compared to internal HLC. External HLC displayed higher all-cause, cancer and other cause mortality for men in the final model adjusted for health-related behaviors, but not for women. Other pathways than health-related behaviors may exist for the association between external HLC and cancer mortality, particularly among men.

Trust in the healthcare system and mortality: A population-based prospective cohort study in southern Sweden

Aims

To investigate associations between trust in the healthcare system and all-cause, cardiovascular, cancer and other causes mortality.

Study design

Prospective cohort study.

Methods

A public health questionnaire was conducted in 2008 in Scania, the southernmost part of Sweden, with a 54.1% participation rate with a postal questionnaire and three reminders. In this study 24,833 respondents were included. The baseline questionnaire study was linked to prospective 8.3-year follow-up cause-specific mortality register data. Survival (Cox) regression analyses were conducted.

Results

A 15.2% proportion of respondents reported very high, 59.1% rather high, and 21.7% not particularly high trust in the healthcare system, while 3.2% reported no trust at all and 0.9% did not know. The groups with rather high and not particularly high trust in the healthcare system had significantly lower all-cause mortality than the reference group with very high trust in the healthcare system. These statistically significant results remained throughout the multiple analyses, and were explained by lower cancer mortality in both the rather high and not particularly high trust respondent groups, and lower cardiovascular mortality in the not particularly high trust respondent group. No significant results were observed in the adjusted models for other causes mortality. No significant results were observed for the no trust and don't know categories in the multiple adjusted models, but these groups are small.

Conclusions

The results suggest a comparative advantage of moderate trust compared to very high trust in this setting of long waiting times for cancer and CVD treatment.

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Trust in the healthcare system and mortality was investigated.

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Rather high and not particularly high trust groups had lower all-cause mortality than the very high trust group.

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The lower mortality was mainly explained by lower cancer mortality.

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The lower mortality was partly explained by lower CVD mortality.

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The findings are associated with long-term queueing for particularly cancer treatment.

Social capital, the miniaturization of community, traditionalism and mortality: A population-based prospective cohort study in southern Sweden

Objectives

To investigate associations between social capital, miniaturization of community and traditionalism and all-cause, cardiovascular (CVD), cancer and other causes mortality.

Study design

Prospective cohort study.

Methods

The 2008 public health survey in Scania in the southernmost part of Sweden was conducted with a postal questionnaire posted to a stratified random sample aged 18–80. The response rate was 54.1%. The baseline survey was linked to 8.3-year prospective public death register data. Analyses were conducted with survival analyses, adjusting for relevant factors.

Results

Among women 37.9% had low social participation and 37.8% low trust. Among men 40.9% had low social participation and 35.7% low trust. Low social capital (low social participation/low trust) and traditionalism (low social participation/high trust) have significantly higher total and cardiovascular mortality among women and men combined and among men, but not among women in the final models. The results for women are not significant in the full models for all-cause, CVD, cancer and all other causes mortality. Miniturization of community (high social participation/low trust) displays no statistically significant associations in the adjusted models. Social participation and trust, respectively, and total mortality show consistent Schoenfeld residuals over 8.3 years.

Conclusions

The associations between low social capital, traditionalism and mortality are stronger for men than for women, and may be partly mediated by health-related behaviors.

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Combinations of cognitive (trust) and structural (social participation) social capital were analyzed.

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Traditionalism and low social capital are associated higher all-cause and CVD mortality among men.

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High social participation/low trust combination does not differ mortality from high social capital combination.

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It may be possible to analyze social capital using intersectional statistical aproaches.

Sexual orientation and all-cause mortality: A population-based prospective cohort study in southern Sweden

Objectives

To investigate associations between sexual orientation and all-cause mortality.

Study design

Prospective cohort study.

Methods

The 2008 public health survey in Scania was conducted with a postal questionnaire later linked to 9.3-year prospective death register data, including 25,071 respondents, aged 18–80. Analyses were conducted with sex-stratified survival analyses.

Results

In the models including age, birth country and socioeconomic status, bisexual men had a hazard rate ratio (HRR) 1.91 (1.10–3.30) compared to heterosexual men, and bisexual women had a HRR 3.18 (1.64–6.18). No significant differences were observed for homosexuals. Other women had a HRR 2.32 (1.47–3.67).

Conclusions

Bisexuals men and women had higher mortality than heterosexuals.

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Studies on sexual identity and mortality are scarce and mostly from the USA.

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Most US studies concern homosexual men, far fewer minority women and bisexuals.

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Bisexual men and women had higher prospective mortality than heterosexuals.

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Mortality among homosexual men and women did not significantly differ from heterosexuals.

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Other women had significantly higher mortality than heterosexual women.

Sexual orientation and poor psychological health: a population-based study

OBJECTIVES

The purpose of this study was to analyse associations between sexual orientation and poor psychological health.

STUDY DESIGN

This was a cross-sectional study.

METHODS

The 2012 public health survey in Scania, Southern Sweden, is a cross-sectional population-based study with 28,029 participants aged 18-80 years. Logistic regression analyses were performed.

RESULTS

The prevalence of poor psychological health (measured using the General Health Questionnaire [GHQ]-12) was 16.3% among men and 22.4% among women. Bisexual men and women had significantly higher odds ratios of poor psychological health throughout the multiple analyses than heterosexual individuals. In contrast, the odds ratios of poor psychological health among gay men and lesbian women were not significantly higher.

CONCLUSIONS

Respondents with bisexual orientation have increased risk of poor psychological health.

Sexual orientation, suicide ideation and suicide attempt: A population-based study

The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18-80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt.