Daylight during winters and symptoms of depression and sleep problems: A within-individual analysis.

BACKGROUND: With climate change Northern areas of the globe are expected to have less daylight during winters due to less snow and more cloudiness. While wintertime has been linked to mental health problems, the role of wintertime daylight has been scarcely studied. We examined longitudinal associations for wintertime objective exposure to global radiation and self-reported daylight exposure with symptoms of depression and sleep problems. METHODS: Our analytical sample included 15,619 respondents from three Swedish Longitudinal Occupational Surveys of Health (2012, 2014 and 2016). Objective exposure was global radiation (MJ/m2, November-January and November-February). Subjective exposure was based on self-reported time spent outdoors in daylight (<1 h vs. ≥ 1 h, November-January). Symptoms of depression were evaluated using a six-item subscale of the (Hopkins) Symptom Checklist. Fixed-effects method with conditional logistic regression controlled for time-invariant participant characteristics by design and time-varying covariates were added into models. RESULTS: One unit increase in the four-month averaged global radiation was associated with lower odds of depressive symptoms (OR 0.69, 95 % CI 0.52-0.91). These findings were confirmed using four-month cumulative exposure (OR 0.91, 95 % CI 0.85-0.98). Individuals reporting ≥ 1 h exposure to daylight during winter months were less likely to report depressive symptoms (OR 0.72, 95 % CI 0.60-0.82) compared to time when their exposure was < 1 h. Higher three-month exposure to global radiation suggested a protective association for sleep problems. CONCLUSION: These findings suggest that higher exposure to daylight during winters may contribute to lower likelihood of depression symptoms.

Regional differences in annual prevalence of sustainable working life in Swedish twin cohort.

The global rise in life expectancy transforms age structure consequently having impact to the sustainability of social protection systems and working life. This descriptive study aimed to illustrate the annual prevalence of sustainable working life across Swedish residential regions, and investigate differences between age groups, sex, or being identical or fraternal twin. The study sample included 81,231 twins with linkage to national register data on sickness absence, disability pension, unemployment, and residential regions. Regions were classified by Swedish municipalities into nine groups. Sustainable working life were then followed in 1998, 2003, 2008, and 2013. Annual prevalence and Generalized Estimating Equation (GEE) with log linear models for interaction test were used. Medium to large size municipalities (15-24%) had higher annual prevalence of sustainable working life than smaller municipalities (1-7%). Young adults in medium to large size municipalities had high annual prevalence of sustainable working life. We found no differences for sexes or being identical or fraternal twin. To conclude, annual prevalence of sustainable working life in 1998, 2003, 2008 and 2013 differed by region being highest in medium to large size municipalities which may have importance for targeting policies, regulations, and practices in a region-specific way. Further studies on residential regions and sustainable working life would be merited to confirm associations and other influential factors.

Trajectories of sustainable working life in nine Swedish residential regions: A longitudinal twin cohort study.

OBJECTIVE: To investigate trajectories of sustainable working life (SWL, ie, no interruptions or transitions in working life due to sickness absence (SA), disability pension (DP), or unemployment) in Swedish residential regions using a population-based twin cohort, while assessing sociodemographics and twin pair similarity. METHODS: Sample of 60 998 twins born in 1925-1958. SWL was assessed through main labor market status in each year in 1998-2016 based on > 180 days with SA/DP, > 180 days with unemployment, or >half of yearly income from old-age pension for not in SWL, and employment (in paid work and did not fulfill the criteria SA/DP, unemployment, or old-age pension) for SWL. Residential regions were classified into nine groups based on Swedish municipalities. Group-based trajectory models and multinomial logistic regression were applied separately for all regions. RESULTS: In all regions, the largest trajectory group was sustainable working life. Three to four trajectory groups developed toward unsustainable working life with different exit points from sustainable working life. A small proportion were grouped with partial stable or increase in sustainable working life. Increased age, being a woman, <12 years of education, and history of unstable working life increased, and being married and twin pair similarity decreased the likelihood of belonging to trajectories toward unsustainable working life. CONCLUSIONS: In all regions, most of the individuals followed a sustainable working life trajectory. A reasonable proportion of individuals followed trajectories developing toward unsustainable working life. The influence of sociodemographic and familial factors on trajectory groups was similar in all regions.

Family-Related Life Events as Predictors of Labor Market Marginalization Trajectories: A Cohort Study of Swedish Twins.

OBJECTIVES: The aims of the study are to investigate trajectories of labor market marginalization (LMM) and to examine the associations between family-related life events and LMM trajectories while accounting for familial factors. METHODS: This is a prospective cohort study of 37,867 Swedish twins. Data were analyzed by group-based trajectory modeling. Associations of family-related life events with trajectory groups were estimated by multinomial logistic regression. RESULTS: Most participants had no or low levels of LMM. Individuals who stayed married over time or changed from single without children to married with children had a decreased risk of LMM. The risk of LMM over time was higher among individuals who changed from married to being single. CONCLUSIONS: Being or getting married as well as having children decreases the risk of LMM while divorce is a risk factor for LMM.

Access to Alcohol Outlets From Home and Work in Sweden: Longitudinal Associations With Problem Drinking.

OBJECTIVE: The association of proximity of alcohol outlets to the workplace with problem drinking has not been previously studied. We examined longitudinal associations of living and working in proximity to alcohol outlets with problem drinking. METHOD: The data consisted of 13,306 employed respondents to the Swedish Longitudinal Occupational Survey of Health between 2012 and 2018. Road distances from the respondents' home and workplace to the nearest liquor outlet, beer outlet, and bar were calculated by Statistics Sweden. We used distance variables both as categorized, to indicate changes in distance, and as continuous variables. Self-reported problem drinking was assessed using modified Cut-Annoyed-Guilty-Eye (CAGE) questions. Binomial logistic regression with generalized estimating equation was used to examine the associations. RESULTS: A decrease (vs. remained unchanged) in the distance from home to a liquor outlet was associated with a higher likelihood of problem drinking (odds ratio = 1.21, 95% confidence interval [1.02, 1.45]). A protective association for problem drinking was observed when the distance from home to a beer outlet increased (vs. remained unchanged) (0.65 [0.44, 0.95]). A decrease (vs. remained unchanged) in the distance from work to a bar was also associated with a higher likelihood of problem drinking (1.37 [1.00, 1.88]). The likelihood of problem drinking was increased also per 1-km decrease in distance from home to liquor outlets (1.01 [1.00, 1.02]), risk estimates being higher for women than for men. CONCLUSIONS: Alcohol outlet proximity to the workplace could be an additional determinant of harmful alcohol consumption behavior. Reducing the number of on- and off-premise alcohol outlets could reduce the level of harmful alcohol consumption.

Distance to sports facilities and low frequency of exercise and obesity: a cross-sectional study.

BACKGROUND: Little research has investigated the associations between proximity to physical activity facilities and behavior-related health and the majority have focused on proximity from home address. We add to the literature by examining proximity of these facilities to work and home address and including a wide range of physical activity facilities. We assess the associations for proximity of physical activity facilities from home and work address with self-reported frequency of exercise and obesity. METHODS: Our analytical sample of 7358 participants was from the 2018 wave of the Swedish Longitudinal Occupational Survey of Health. We used logistic binomial regression adjusting for age, sex, education, civil status, individual socioeconomic status, neighborhood socioeconomic status, number of children under 12 years of age, work strain, and chronic disease. RESULTS: Longer distance from home to paid outdoor and paid indoor physical activity facilities was associated with low frequency of exercise (fully adjusted Relative Risk for both 1.01, 95% CI 1.01-1.02). Associations of any or free outdoor facility with low frequency of exercise were not robust. Findings also indicated associations between long distance from workplace to any and paid outdoor facility and low frequency of exercise. Results for obesity were in the similar direction, however, these were not statistically significant. CONCLUSION: Increased distance of paid outdoor and paid indoor physical activity facilities from home and of paid outdoor facilities from work was associated with low frequency of exercise. Longitudinal and larger studies are needed to confirm our findings, particularly regarding obesity.

Night Work and Sustainable Working Life-A Prospective Trajectory Analysis of Swedish Twins.

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

Commuting distance and behavior-related health: A longitudinal study.

Health benefits of active commuting and short commuting time are well-documented; however, limited evidence exists on the effects of commuting distance. We examined longitudinal associations between commuting distance and behavior-related health. Participants were from four survey waves of the Swedish Longitudinal Occupational Survey of Health (2012, 2014, 2016, and 2018). Analytical sample included 11,023 individuals and 21,769 observations. Random effects method used binomial logistic regression with generalized estimating equations. The outcomes were self-reported physical inactivity, overweight, smoking, problem drinking, and disturbed sleep. Models were adjusted for age, sex, occupational position, civil status, chronic disease, work strain, number of children under 12, and home/workplace neighborhood socioeconomic status. Using continuous measure, long commuting distance was associated with a higher odds of physical inactivity (OR 1.06; 95% CI, 1.04-1.09 per doubling of distance), overweight (OR 1.02; 95% CI, 1.00-1.04), and disturbed sleep (OR 1.03; 95% CI, 1.00-1.05) in fully adjusted models. Using categorized measure, individuals who commuted longer distance had a higher odds of physical inactivity compared to those with the shortest commute (3.1 km - <7.9 km vs. <3.1 km: OR 1.15; 95% CI, 1.04-1.28 and 7.9 km - <20 km vs. <3.1 km: OR 1.18; 95% CI, 1.06-1.32, fully adjusted model). Such dose-response associations were not observed for overweight or disturbed sleep. Our results suggest short commuting distance may be beneficial for behavior-related health.

Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health: A Within-individual Analysis.

BACKGROUND: The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES. OBJECTIVE: To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals. METHODS: We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep. RESULTS: After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02-2.87). No associations were observed for the other outcomes. CONCLUSION: These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.

Ozone and cardiac arrest: The role of previous hospitalizations.

BACKGROUND: Several studies have reported associations between exposure to particulate matter and incidence of out-of-hospital cardiac arrest (OHCA) and some have observed associations with ozone (O3). There are no studies investigating susceptibility based on previous disease history to short-term O3 exposure and the risk of OHCA. AIM: To investigate the role of previous cardiovascular-related hospitalizations in modifying the associations between the risk of OHCA and short-term increase in O3 concentrations. METHODS: A time-stratified case-crossover analysis of 11,923 OHCA registered in the Swedish Register for Cardiopulmonary Resuscitation from 2006 to 2014 was performed. Using personal identification numbers, OHCA were linked to all previous hospitalizations in Sweden since 1987 to create susceptible groups based on the principal diagnosis code at discharge. Susceptibility was based on hospitalization for i) acute myocardial infarction; ii) heart failure; iii) arrhythmias; iv) diabetes; v) hypertension; and vi) stroke. Moving 2 and 24-h averages for O3, PM2.5, PM10, and NO2 were constructed from hourly averages. RESULTS: A 10 µg/m3 higher 2-h average O3 concentration was associated with a 2% higher risk of OHCA (95% CI, 0% 3%). Associations were similar for 24-h average O3 and in individuals with or without hospitalizations for AMI, heart failure, diabetes, hypertension or stroke. Individuals with previous hospitalizations for arrhythmias had a lower risk of OHCA with higher O3. No associations were observed for other pollutants. CONCLUSIONS: Short-term exposure to O3 was associated with an elevated risk of OHCA, however, previous hospitalizations for cardiovascular diseases were not associated with additionally augmented risks.

Susceptibility to short-term ozone exposure and cardiovascular and respiratory mortality by previous hospitalizations.

BACKGROUND: Ozone (O3) has been associated with cardiorespiratory mortality although few studies have explored susceptible populations based on prior disease. We aimed to investigate the role of previous hospitalization on the association between short-term exposure to O3 and cardiovascular (CV) and respiratory mortality. METHODS: We performed time series analyses using generalized additive models and case-crossover on 136,624 CV and 23,281 respiratory deaths in Stockholm County (1990-2010). Deaths were linked to hospital admissions data. We constructed 2-day and 7-day averages using daily 8-h maximum for O3 and hourly values for PM2.5, PM10, NO2, and NOx from a fixed monitor. RESULTS: We observed a 0.7% (95% CI: 0.1%, 1.3%) and 2.7% (95% CI: 0.8%, 4.6%) higher risk of CV and respiratory death per 10 µg/m3 higher 2-day and 7-day average O3 respectively. Individuals previously hospitalized for myocardial infarction demonstrated 1.8% (95% CI: 0.4%, 3.4%) higher risk of CV death per 10 µg/m3 higher 2-day average O3 and similar associations were observed in individuals with no previous hospitalization for any cause. Individuals with previous hospitalizations did not show susceptibility towards O3-related risk of respiratory mortality. We observed no associations for other pollutants. CONCLUSION: Short-term ozone exposure is associated with CV and respiratory mortality and our results may suggest higher susceptibility to CV mortality following O3 exposure in individuals previously hospitalized for myocardial infarction. Higher risks were also observed in individuals with cardiovascular death as their first presentation of disease.

Short-term Exposure to Ozone and Mortality in Subjects With and Without Previous Cardiovascular Disease.

BACKGROUND: Exposure to ground level ozone (O3) is a public health problem associated with a range of risks across population subgroups. Our aim was to investigate the role of previous cardiovascular diseases (CVDs) in mortality related to short-term O3 exposure. METHODS: Deaths between 1990 and 2010 in Stockholm County were matched with previous hospitalizations in Swedish registries. An urban background monitoring station provided hourly values of air quality data, from which we calculated 8-hour running averages and daily 8-hour maximum. We analyzed associations between daily O3 concentrations and mortality among persons with and without previous CVD hospitalization with a generalized additive model adjusted for time trend, influenza, and weather. We also performed two-pollutant models. RESULTS: There were 302,283 nontrauma-related deaths, out of which 196,916 had previous CVD hospitalization. The mean concentration of daily maximum 8-hour O3 was 62.9 µg/m. An average 10 µg/m increase in the same and preceding day was associated with an increased mortality of 1.72% (95% confidence interval: 0.44%, 3.02%) in those with prior admission for acute myocardial infarction (AMI), which was more than three times higher than for those with no previous AMI (0.50, 95% confidence interval: 0.10%, 0.89%, P value for interaction 0.098). The association between O3 and mortality remained essentially unchanged in two-pollutant models with NO2, NOx, and PM10. CONCLUSIONS: Our study indicates that short-term exposure to O3 is associated with increased mortality in those with a previous hospitalization for AMI.

Short-term departures from an optimum ambient temperature are associated with increased risk of out-of-hospital cardiac arrest.

BACKGROUND: Associations have been reported between daily ambient temperature and all-cause and cardiovascular mortality. However, the potential harmful effect of temperature on out-of-hospital cardiac arrest (OHCA) is insufficiently studied. OBJECTIVES: The objective of this study was to investigate the short-term association between ambient temperature and the occurrence of OHCA. METHODS: In 5961 cases of OHCAs treated by Emergency Medical Service occurring in Stockholm County we investigated the association between the preceding 24-h and 1h mean ambient temperature, obtained from a fixed monitoring station, and OHCA using a time-stratified case-crossover design. RESULTS: We observed a V-shaped relationship between preceding mean 24-h and 1-h ambient temperature and the occurrence of OHCAs. For mean 24-h temperature we observed an odds ratio (OR) of 1.05 (1.00-1.11) for each 5°C below the optimum temperature and 1.05 (0.96-1.18) for each 5°C above the optimum. We observed similar results for 1-h mean temperature exposure. Results for temperatures above the optimum temperature showed evidence of confounding by ozone. CONCLUSION: Ambient temperature below an optimum temperature was associated with increased risk of OHCA in Stockholm. Temperature above an optimum temperature was not significantly associated with OHCA.

Short-term effects of air pollution on out-of-hospital cardiac arrest in Stockholm.

BACKGROUND: Although ozone (O3) and other pollutants have been associated with cardiovascular morbidity and mortality, the effects of O3 on out-of-hospital cardiac arrest (OHCA) have rarely been addressed and existing studies have presented inconsistent findings. The objective of this study was to determine the effects of short-term exposure to air pollution including O3 on the occurrence of OHCA, and assess effect modification by season, age, and gender. METHODS AND RESULTS: A total of 5973 Emergency Medical Service-assessed OHCA cases in Stockholm County 2000-10 were obtained from the Swedish cardiac arrest register. A time-stratified case-crossover design was used to analyse exposure to air pollution and the risk of OHCA. Exposure to O3, PM2.5, PM10, NO2, and NOx was defined as the mean urban background level during 0-2, 0-24, and 0-72 h before the event and control time points. We adjusted for temperature and relative humidity. Ozone in urban background was associated with an increased risk of OHCA for all time windows. The respective odds ratio (confidence interval) for a 10 µg/m(3) increase was 1.02 (1.01-1.05) for a 2-h window, 1.04 (1.01-1.07) for 24-h, and 1.05 (1.01-1.09) for 3 day. The association with 2-h O3 was stronger for events that occurred outdoors: 1.13 (1.06-1.21). We observed no effects for other pollutants and no effect modification by age, gender, or season. CONCLUSION: Short-term exposure to moderate levels of O3 is associated with an increased risk of OHCA.