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Projection studies have often focused on mortality and, more recently, migration. Fertility is less studied, although even small changes can have significant repercussions for the size and age structure of future populations. Across Europe, there is no consensus on how fertility is best projected. In this article, we identify different approaches used to project fertility among statistical agencies in Europe and provide an assessment of the different approaches according to the producers themselves. Data were collected using a mixed-method approach. First, European statistical agencies answered a questionnaire regarding fertility projection practices. Second, an in-depth review of select countries was performed. Most agencies combine formal models with expert opinion. While many attempt to maximise the use of relevant inputs, there is more variation in the detail of outputs, with some agencies unable to account for changing age patterns. In a context of limited resources, most are satisfied with their approaches, though some are assessing alternative methodologies to improve accuracy and increase transparency. This study highlights the diversity of approaches used in fertility projections across Europe. Such knowledge may be useful to statistical agencies as they consider, test and implement different approaches, perhaps in collaboration with other agencies and the wider scientific community.

Women's health status may affect their opportunities and preferences for children through various mechanisms. We examine the relationship between health and fertility using Norwegian registry data (2004-18). Measuring verifiable and persistent health problems, we use uptake of doctor-certified sickness absence and long-term health-related benefits as proxies for health. In contrast to the expectation that poor health limits women's opportunities for children, our results show that sickness absence is positively associated with transitions to parenthood. The uptake of long-term benefits is, however, negatively associated with fertility. The selection of healthy women into parenthood weakens the association for higher-order births. The impact of long-term health indicators on fertility is comparable in magnitude to that observed for more conventional predictors, such as education and income. With continued postponement of childbearing and thus higher maternal ages, the influence of health as a fertility determinant is likely to grow and further research appears warranted.

The role of intergenerational geographic proximity in individuals' migration decisions has been well-established. The circumstances under which parents and their adult children move away from or remain close to each other are, however, less clear. Drawing on Norwegian register data for 2014–2016 and three-level logistic regression models, we examine whether formal care needs of older parents (aged ≥65) deter parent-child geographic divergence and whether variation in the likelihood of divergence is associated with municipal-level characteristics. After accounting for location-specific capital and parents' and children's sociodemographic characteristics, parents and children were less likely to diverge after the onset of parental care needs. Utilising in-home nursing decreased the likelihood of divergence for mothers while utilising institutionalised care decreased the likelihood of divergence for fathers. The use of in-home nursing care among single mothers further reduced the likelihood of divergence. Parents and adult children living in central areas were the least likely to diverge geographically. The likelihood of intergenerational divergence was lower for fathers and children living in municipalities with high healthcare spending.

Antall innvandrere i Norge vil øke framover, men utelukkende i de eldre aldersgruppene. I aldersgruppen 55-66 år vil det bli nesten tre ganger så mange innvandrere de neste 20 årene. Hva vil dette bety for norsk arbeids- og samfunnsliv? Vil de være i jobb? Denne artikkelen undersøker hva som vil kjennetegne de eldre innvandrerne framover – deres bakgrunn, utdanning, sysselsetting og hvor i Norge de vil bo. Våre resultater tyder på at framtidens eldre innvandrere i snitt vil ha betydelig lavere utdanningsnivå og arbeidsdeltakelse enn innfødte på samme alder. Det kan gi utfordringer både for integrerings- og seniorpolitikken. The number of immigrants in Norway will increase in the future, but exclusively in older age groups: We can expect almost three times as many immigrants aged 55-66 in the next 20 years, according to population projections. This article describes likely characteristics of the many older future immigrants (e.g. origin, length of stay, gender, education, place of residence and employment), and discusses potential labour market implications and societal consequences. It may pose a challenge that future older immigrants are likely to be significantly lower educated and have lower labour-market participation rates than natives of the same age.

Aims: United States’ (US) colorectal cancer (CRC) screening and treatment practices seek to reduce mortality. We examined the survival of US patients compared with patients in the virtually unscreened Norwegian population. Methods: We compared short-term survival after CRC between the US and Norway using relative survival (RS) and excess mortality (EMR) analyses. The CRC patients were aged 50 and older diagnosed in the US (Surveillance, Epidemiology and End Results registry, 2004, N=9511) and in Norway (Cancer Registry of Norway, 2003–2005, N=8256). Results: Death occurred within three years for 39% of the CRC patients. Stage distributions were more favorable for US patients. Stage-specific survival was similar for localized and regional cancers, but more favorable for US distant cancers. In multivariate models of patient, tumor and treatment characteristics, patients (especially below age 80) in the US experienced longer survival (EMR 0.9, CI 0.8–0.9). Stage-specific analyses showed, however, that survival for localized cancers was relatively shorter in the US than in Norway (EMR 1.4, CI 1.1–1.8), but longer for distant cancers (EMR 0.8, CI 0.7–0.8). Conclusions: The enhanced survival for US CRC patients likely reflects a screening-related earlier diagnostic stage distribution, as well as prioritized life extension for patients with metastatic cancers, reflecting vastly different health care systems in the two countries. CRC screening is currently under consideration in Norway. For survival outcomes, the current findings do not discourage such an implementation. Other screening-related aspects such as feasibility and cost-benefit are, however, also relevant and warrant further research within a socialized health system.

All political parties in Norway agree that social inequalities in health comprise a public health problem and should be reduced. Against this background, the Council on Social Inequalities in Health has taken action to provide specific advice to reduce social health differences. Our recommendations focus on the entire social gradient rather than just poverty and the socially disadvantaged. By proposing action on the social determinants of health such as affordable child-care, education, living environments and income structures, we aim to facilitate a possible re-orientation of policy away from redistribution to universalism. The striking challenges of the causes of health differences are complex, and the 29 recommendations to combat social inequality of health demand cross sectorial actions. The recommendations are listed thematically and have not been prioritized. Some are fundamental and require pronounced changes across sectors, whereas others are minor and sector-specific.

“NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Economic Behavior & Organization. Changes resulting from the publishing process, such as editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Jakobsson, N., Kotsadam, A., Syse, A., & Oien, H. (2015). Gender bias in public long-term care? A survey experiment among care managers. Journal of Economic Behavior & Organization. http://dx.doi.org/10.1016/j.jebo.2015.09.004”

Suicide risk in adult cancer patients is found to be elevated, but limited information exists regarding risks of suicide and non-suicidal violent deaths when diagnosed with cancer in young age. We investigate suicide and violent deaths in a national cohort including individuals diagnosed with cancer before age 25. Through the linkage of different national registries (Cancer Registry of Norway, Norwegian Causes of Death Registry, and the National Registry) a cohort of all live births in Norway during 1965-1985 was defined and followed up through 2008. Individuals diagnosed with cancer before age 25 and the cancer-free references were compared using an extended Cox proportional hazard regression model. The cohort comprised 1,218,013 individuals, including 5,440 diagnosed with cancer before age 25. We identified 24 suicides and 14 non-suicidal violent deaths in the cancer group. The hazard ratio (HR) of suicide in the cancer group was 2.5 (95% confidence interval (CI) 1.7-3.8), and was increased both when diagnosed with cancer in childhood (0-14 years of age); HR=2.3 (95% CI 1.2-4.6), and during adolescence/young adulthood (15-24 years); HR=2.6 (95% CI 1.5-4.2). Survivors of bone/soft tissue sarcomas, CNS tumors and testicular cancer were at particular risk. The risk of non-suicidal violent death was not increased in the cancer survivors (HR=1.0; 95% CI 0.6-1.7). Although based on small numbers and the absolute risk of suicide being low, these are novel findings with important implications for establishing adequate follow-up including suicide prevention strategies for young cancer survivors. This article is protected by copyright. All rights reserved.© 2016 UICC. Language: en

1. IntroductionMortality is an indicator of health and disease risk (Razum et al. 1998). Studying differences in mortality between migrant and minority groups and the majority population might improve our understanding of the underlying mechanism. Mortality data from migrant groups in Norway could provide us with important insights, as there is a scarcity of data from Nordic countries. Secondly, in contrast to other Nordic welfare societies like Sweden, which has a longer period of immigration, Norway has seen a rapid rise in the migrant population, from negligible a few decades ago to a substantial part of the population being foreign-born today (14%). In an international context, Norway thus has a short immigration history and a comparatively late aging of the immigrant population. Furthermore, immigrant flows have been relatively fragmented, resulting in fluctuating stocks of immigrants, varying over time. This has resulted in large heterogeneity in the immigrant pool. In the past decade a large proportion of migrants have originated from low-income and/or Eastern European countries (Statistics Norway 2016). Given the origins of recent migrants, it might be assumed they are disadvantaged compared to the host population and therefore have poorer health or, on the contrary, that their health potential is better.Besides being dynamic and heterogeneous, until recently the immigrant population has not been sufficiently numerous to warrant studies examining differences in Norwegian mortality. The Norwegian context is particularly interesting due to the country's egalitarian welfare policies, including freely available health care. Furthermore, social and gender equity policies have resulted in lower levels of inequality than elsewhere.1.1 The Norwegian settingThe immigrant population in Norway, comprising immigrants and their descendants, has gradually increased from 1% in the early 1970s to 15% today (Statistics Norway 2016). It is expected to continue to increase quite substantially over the coming years (Cappelen, Skjerpen, and Tonnessen 2015). Norway's immigration policy was fairly liberal post-World War II. In the 1950s, immigrants comprised around 1% of the population and were mostly from Sweden, followed by refugees from Eastern Europe and thereafter by labor immigrants from other parts of the world. The post-1975 freeze on labor migrants meant that majority of migrants to Norway thereafter were refugees from Asia, Africa, South America, and Eastern Europe. However, with the expansion of the European Union (EU) in 2004 there was a marked increase in labor immigration from new EU countries, particularly Poland and Lithuania. The history of migration to Norway shows that the reasons for migration have varied over time, thereby influencing the composition of the immigrant population in Norway. For the study period 1990- 2012, family reunification, employment, education, and refuge from conflict, political oppression, persecution, and natural disasters represented 39%, 31%, 6%, and 22% of the reasons for immigration, respectively.Over the past five years the immigrant population in Norway has increased by almost 50%, from 552,000 to 804,000 (Statistics Norway 2016). Norway's immigrant population is heterogeneous and migrants originate from 221 different countries with the largest groups coming from Poland, Sweden, Somalia, Lithuania, Pakistan, and Iraq. In 2014 the largest groups arrived from Poland, Lithuania, and Eritrea.Despite the dramatic rise in migration, Norway is not the first country of choice for many migrants. As was previously the case, most migrants prefer the UK, Germany, and/or Switzerland (IOM 2015). Norway has not been a colonial power and therefore has no migration from former colonies, as in the Netherlands and the UK. Furthermore, prior to finding oil in 1970 Norway was a relatively poor country, which, together with a cold, harsh climate, may have deterred migration. …

To study relations between childhood residential mobility and early adult outcomes, we use detailed longitudinal data on complete cohorts born in Norway between 1965 and 1980 ( N = 967 151) and information on all their relocations between municipalities. Results from models with and without sibling-fixed effects show that children with more residential moves are more likely to drop out of high school, to have a lower adult income and to experience early parenthood, although most of these associations are weaker in the sibling fixed effects models. We also find that age at moving matters: the outcomes are similar for children who move or remain in place prior to elementary school, whereas those who move in adolescence are worse off than those who do not.

On average, people who retire earlier die sooner, partly because poor health is an important reason for early retirement. Several theories also predict that retirement is detrimental to health and increases mortality, and that retirement should affect people in different occupations differently. Yet, there is apparently no consensus about the causal relationship between retirement and mortality. We treat a Norwegian pension reform that lowered retirement eligibility age by 3 years in 1973 as a natural experiment. The reform affected virtually the entire elderly working population. We estimate the long-term effect of retirement age and the short-term effect of retirement eligibility using instrumental variables and difference-in-differences methods. The results show that neither earlier retirement nor retirement eligibility affect male mortality substantially. Analyses by educational level and occupational groups show no occupational or educational differences in the effect of retirement on mortality. We also argue that the 1973 reform serves as a critical case, a situation where we should be able to identify an effect if there were one. In other words, this study provides strong evidence that retirement does not have a causal effect on male mortality.

The number of young cancer survivors has increased over the past few decades due to improvement in treatment regimens, and understanding of long-term effects among the survivors has become even more important. Educational achievements and choice of educational fields were explored here. Five-year cancer survivors born in Norway during 1965–1985 (diagnosed

The aim of this longitudinal qualitative interview study (3 waves of interviews) was to examine the nature of older workers’ late career decision-making processes, including the main drivers and obstacles for prolonging working life or retiring. Late career decision-making is regarded as a process of reflecting and deciding on whether to continue in the current job, change employer, be self-employed, or quit one’s career when approaching retirement. The general results of our interviews revealed that interviewees were positive about continuing to work in their current positions. Job and learning demands were appreciated, and retirement decisions were postponed by 1 year; a consistent theme across the 3 waves of interviews. Only a few changed their opinions completely. Few reported on possibilities for job crafting. Bridge employment was regarded as an alternative to the current employer or as a smooth transition into retirement. Reasons to continue working were multi-faceted; hence, data are presented using a baseline description followed by 5 rich narratives to illustrate the width of the data. Together, these findings suggest that plans for late career and retirement decisions emerge and mature over the years prior to retirement. This study contributes to the understanding of the complex nature of older workers’ late careers, and extends our knowledge of the retirement decision process. The study informs leaders about drivers and obstacles for employees to continue working, and may have implications for future human resource planning and management.

Research on the correspondence between retirement intentions and subsequent behaviour is scarce. We aimed to explore possible associations between retirement intentions and behaviour, using five-year high-quality quantitative panel data on Norwegian senior workers. Retirement intentions operate at different levels of firmness: (a) considerations; (b) preferences; and (c) decisions. Compared to work continuation considerations, a targeted age for retirement improved predictive power whether the target was preferred or decided, and particularly so if the target (i.e.the preferred or decided age of retirement), corresponded with a normative retirement age. Because more workers are able to state a preferred age of retiring than a decision about when to retire, preferences may be better proxies for retirement behaviour than decisions, when the issue is planning for policies. The correspondence between intentions and behaviour varies primarily by health, education and type of work. Older workers with poor health, and workers with low education, often retire earlier than they prefer. Blue-collar workers often retire earlier than they had decided. These findings illustrate the possible effect of labour market resources, not only for senior workers' labour market participation, but also for their opportunities to work up to the age they prefer or had decided. Even for white-collar workers and those in good health, constraints seem to apply when they wish to retire late.

Background: As the number of cancer survivors increases, their health and welfare have come into focus. Thus, long-term medical consequences of cancer at a young age (

Suicide risk in adult cancer patients is found to be elevated, but limited information exists regarding risks of suicide and non-suicidal violent deaths when diagnosed with cancer in young age. We investigate suicide and violent deaths in a national cohort including individuals diagnosed with cancer before age 25. Through the linkage of different national registries (Cancer Registry of Norway, Norwegian Causes of Death Registry and the National Registry) a cohort of all live births in Norway during 1965-1985 was defined and followed up through 2008. Individuals diagnosed with cancer before age 25 and the cancer-free references were compared using an extended Cox proportional hazard regression model. The cohort comprised 1,218,013 individuals, including 5,440 diagnosed with cancer before age 25. We identified 24 suicides and 14 non-suicidal violent deaths in the cancer group. The hazard ratio (HR) of suicide in the cancer group was 2.5 (95% confidence interval (CI) 1.7-3.8), and was increased both when diagnosed with cancer in childhood (0-14 years of age); HR = 2.3 (95% CI: 1.2-4.6), and during adolescence/young adulthood (15-24 years); HR = 2.6 (95% CI: 1.5-4.2). Survivors of bone/soft tissue sarcomas, CNS tumors and testicular cancer were at particular risk. The risk of non-suicidal violent death was not increased in the cancer survivors (HR = 1.0; 95% CI: 0.6-1.7). Although based on small numbers and the absolute risk of suicide being low, these are novel findings with important implications for establishing adequate follow-up including suicide prevention strategies for young cancer survivors.

Married cancer patients enjoy a survival advantage, potentially attributable to better health at diagnosis, earlier contact with health personnel, and/or access to resources to ensure more optimal treatment. These mechanisms only invoke the mere presence of a partner, but partners bring varying amounts of resources into the household. It is likely that also spousal resources contribute to differentials in survival net of own resources, as gradients in survival by the latter are well documented. Our aim is to examine the combined roles of own and spouses’ socioeconomic characteristics (SES) and age for cancer survival. Almost 268,000 married patients diagnosed with a first cancer after age 50 during 1975–2007 were identified from the Norwegian Cancer Registry and other national registers. In a sequence of hazard models, differences in survival by patients' own education, income and age and the role of spouses' characteristics were assessed. Furthermore, we also assessed the importance of homogamy/heterogamy along the same dimensions. Partners’ characteristics clearly matter for survival. The relative survival of patients with highly educated partners, net of their own education, is significantly higher than that of patients with lesser-educated partners. Somewhat similar effects are observed for income, net of education. A less consistent pattern is observed for age, although non-normative heterogamy patterns in age and income appear to be associated with a survival disadvantage. The naïve perspective of only considering the presence of partners may thus conceal important differences in cancer survival. Health personnel may take advantage of such knowledge in interactions with patients and their families, and gather information on resources in immediate networks that may impact prognosis favorable and/or unfavorable and help patients utilize these resources to improve prognosis., Highlights • For married cancer patients, survival is influenced by the resources of spouses. • As such, who you marry play a role for your survival. • Having a highly educated and/or a high earning spouse appears to be beneficial. • But, non-normative spousal patterns in age and SES appear to be disadvantageous. • Married patients’ spousal resources may help shed light on inequalities in survival.

BACKGROUND The impact of cancer on socioeconomic outcomes is attracting attention as the number of survivors of cancer in young age continues to rise. This study examines economic independence in a national cohort of survivors of cancer at a young age in Norway. METHODS Through the linkage of several national registries, the study cohort comprised 1,212,013 individuals born in Norway during 1965 through 1985, of which 5440 had received a cancer diagnosis before age 25 years. Follow‐up was through 2007, and the main outcomes were receipt of governmental financial assistance, employment, income, and occupation. Analytic methods included Cox proportional hazard regression, log‐binomial regression, and quantile regression models. RESULTS Individuals in the cancer survivor group had an increased probability of receiving governmental financial assistance (men: hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3‐1.5; women: HR, 1.5; 95% CI, 1.3‐1.6) and of not being employed (men: HR, 1.4; 95% CI, 1.2‐1.7; women: HR, 1.4; 95% CI, 1.2‐1.6) compared with those in the noncancer group. Income discrepancies were particularly pronounced for survivors of central nervous system tumors. There was no difference in representation in higher skilled occupations. CONCLUSIONS Survivors of cancer at a young age in Norway had an increased risk of being economically dependent and unemployed. This was evident in several tumor groups and was most pronounced in female survivors. There were only small differences in income or representation in higher skilled occupations for most employed survivors compared with the noncancer group. The current results are important for understanding the impact of a cancer diagnosis at a young age on subsequent job market outcomes. Cancer 2016;122:3873–3882. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society., Cancer during childhood, adolescence, and young adulthood can influence subsequent economic and occupational outcomes. In a national cohort study from Norway, increased economic dependence and unemployment is demonstrated; however, overall, there are no substantial differences in income or occupational fields among survivors of cancer diagnosed before age 25 years when compared with cancer‐free references except for survivors of central nervous system tumors.

Cancer is one of the most common causes of death among young individuals. The purpose of this study was to explore the risk of early death (the first five years after diagnosis) among children (0–14 years), adolescents (15–19 years), and young adults (20–24 years) with cancer in Norway, born during 1965–1985. The overall and cancer-specific early deaths were explored by linking population-based national registers (including the Cancer Registry of Norway and the Cause of Death Registry) that include the entire population of Norway (approximately 1.3 million individuals). Hazard and sub-hazard ratios were estimated using Cox regression analyses and competing risk models. A total of 5,828 individuals were diagnosed with cancer (56.3 % males). During follow-up, 1,415 individuals died from cancer (60.2 % males) within five years after diagnosis. The hazard ratio (HR) of overall death of the cancer patients relative to the general population decreased from 1965 (from HR, 385.8 (95 % confidence interval (CI): 335.3, 443.4) in 1965-74 to HR, 19.7 (CI: 9.3, 41.5) in 2005-09). Over all, there were fewer cancer-related deaths among female compared with male patients (sub-hazard ratio (SHR), 0.83 (CI: 0.74, 0.92)). Except for all hematopoietic malignancies, adolescents and young adult patients had lower risk of cancer death than children. The difference in risk of cancer and overall deaths between the cancer patients and the general population has been substantially reduced since 1965.

At a group level, cancer results in reduced labor earnings. Public benefits common to welfare states may, however, compensate for all or parts of the decline in earnings. Norwegian cancer survivors' incomes, including both labor earnings and compensatory welfare benefits, were compared to those of the cancer-free population to assess potential welfare consequences of cancer. Possible modifying effects of parental and marital status, education, prior earnings and age were assessed in depth.Log-linear regression models were used to estimate incomes across different sociodemographic variables using register data covering the entire Norwegian population 40-59 years old with any income in 2008, 536 600 men and 502 500 women, of whom more than 17,000 were diagnosed with cancer in 2000-2007.Compared to the cancer-free general population, cancer was associated with a modest 7% decline in incomes overall. The decline was, however, significantly associated with sociodemographic factors, marital status exempted. Childless men with low education and low prior earnings were most adversely affected. Lymphomas and lung cancer accounted largely for these unfavorable effects.Declines in earnings after cancer are to a large degree compensated by the Norwegian welfare state, and incomes overall are only modestly decreased among cancer survivors compared to the general population. Persons with multiple unfavorable sociodemographic characteristics experience particularly low incomes after cancer. This is of concern in a supposedly egalitarian society with public health care and antidiscrimination acts in place. Welfare state interventions, i.e. work reintegration efforts and/or compensations for labor earning drops, directed specifically towards these subgroups might be warranted.

Increased attention is being paid to the long-term health and well-being of people living with a history of cancer. Of particular concern is cancer's effect on productivity and work ability, which in turn is important for persons' financial situation, life satisfaction, and social relationships. We explored the extent to which Norwegian cancer survivors stay affiliated to working life compared to the cancer-free population, and quantified cancer-associated earning declines.Logistic regression models were estimated to explore the impact of cancer on employment using register data covering the entire Norwegian population in 2001, 567,000 men and 549,300 women 40-59 years old, of whom 34,000 were diagnosed with cancer. These analyses revealed that a cancer diagnosis was strongly associated with not being employed. Log-linear regression models were used to estimate the effect of cancer on labor earnings in 2001 for those employed. Cancer was associated with a 12% decline in earnings overall. Leukemia, lymphomas, lung, brain, bone, colorectal, and head-and-neck cancer resulted in the largest reductions in employment and earnings. Earning declines were strongly associated with educational level. In addition, linear regression models were used to estimate differentials in earnings before and after cancer. These results accorded well with those from cross-sectional models.Cancer survivors are less likely to be employed than the cancer-free population, and undertake modifications in their employment, e.g. reduce work-hours or hold lower-wage jobs, which result in reduced earnings. A social class gradient is present and must be addressed to accommodate appropriate intervention from welfare societies.

Discrete-time hazard regression models were employed to register and census data on 1.4 million Norwegian married couples from 1974-2001 to explore the probability of divorce following cancer illness. Divorce rates for around 215 000 persons diagnosed with cancer were compared to divorce rates for persons for whom all the other observed variables were the same. No overall harmful influence of a cancer diagnosis was observed. Most cancer forms resulted in small, immediate declines in divorce rates the first years following diagnosis. Exceptions were significant increases in the divorce rates for persons diagnosed with cervical and testicular cancer. 1. Introduction Cancer strikes the population in developed countries heavily. In Norway, between one-third and one-half of the population will ever be diagnosed with a malignant disease, and more than one-fifth of the deaths are reckoned as due to such diseases. Although the cancer incidence generally rises with age, thereby causing the number of cancer patients to increase sharply in ageing populations, many also get the disease as children, adolescents, or young adults. The possibility of surviving and not having severe symptoms is, of course, the key issue for a cancer patient and his or her family, and society's efforts are to a large extent directed towards providing potentially curative treatment or palliative care. However, the quality of life in a somewhat broader perspective among those who are about to deal with the disease, or those who apparently have survived and regained their health, is also a legitimate concern. Are people with a cancer diagnosis for example more likely to have economic problems in the long run than others? Will they be able to reach their educational goals? How are their chances of finding a spouse or partner, becoming parents, or having more children? Will their marital relationships take a turn for the better or worse? Knowledge of common outcomes may help individual patients and families plan their lives, and serve as an important basis for any societal attempts to assist. Our analysis explores how cancer affects the probability of divorce among Norwegian couples. In addition to being an important question for those concerned with cancer patients' welfare, it would be interesting from a more general family-behaviour perspective to learn how a stressful event and process such as a malignant disease affects marital relationships. Several investigations suggest that people with poor health are less likely than others to enter marital unions and have satisfactory and long-lasting relationships (e.g. Blekesaune, Overbye, and Romoren 2003, Joung et al. 1998, Lillard and Panis 1996, Waldron, Hughes, and Brooks 1996). Cancer does not, however, necessarily have the same impact on family relations as other common illnesses. The development of a malignant disease is often particularly hard to predict, the lethality is very high in many cases, and such a disease may not be associated with the same stigma as those that are more obviously a result of people's life-style and lack of socioeconomic resources (Goldberg and Cullen 1985). Few studies have focused on the effect of cancer in particular, and they have often been based on small samples and been limited to the first years after diagnosis. Most of these small studies have shown no change, or a decrease, in the divorce probability after cancer (Joly et al. 2002, Dorval et al. 1999, Joly et al. 1996, Rieker et al. 1989), but there have been indications of increased marital instability after brain cancer (Glantz et al. 2001, Byrne et al. 1989). In this study, we estimate how divorce rates are influenced by various common cancer forms among women and men, using data for the entire Norwegian population extracted from the Cancer Registry, the Central Population Register and recent censuses. No earlier investigation has employed such a large data material. …

Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later ( N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life.

Background: Increased survival after cancer in young age has made long-term follow-up studies of high external validity important. In this national cohort study, we explored the impact of cancer in young age on reproduction and marital status in male survivors. Methods: Hazard ratios (HRs) and relative risks (RRs) of reproductive and marital outcomes were studied for male survivors of cancer in young age (

The role of cancer coordinators in cancer care collaboration in Norwegian municipalitiesUncoordinated services represent a pronounced challenge in Norwegian health care. To enhance local cancer care, a trial project implementing cancer coordinator positions in several Norwegian municipalities was launched in 2012. We aim to assess the role cancer coordinators play in the local coordination of cancer care. In 2014, 52% of cancer coordinators in Norwegian municipalities answered a quantitative web survey concerning their role. Cancer coordinators work directly with patients and their families, but are also a resource for other service providers. Collaboration with involved parties is generally adequate, although interactions with general practitioners, NAV, schools and kindergartens could be improved. Cancer prevalence will increase due to population aging, and thus pressure municipal health services. Cancer coordinators report that they contribute positively in local cancer care. Future research should include perspectives also from patients, next-of-kin and collaborating partners, and potential differences in municipalities with and without cancer coordinators should be explored.

Research on spouses’ joint work exits is scarce, although household factors such as spouses’ work status, marital quality, and caregiving burdens are likely to affect seniors’ work engagement. We therefore examine whether the work exit probability of one spouse affects that of the other. Discrete-time hazard regression analyses of survey data linked to later registry information including all gainfully employed married respondents aged 50–74 with a working spouse ( N = 1,764) were used to assess subsequent work exits. A spouse’s work exit is a strong predictor of a respondent’s work exit (hazard ratio 3.1, 95% confidence interval [2.5, 4.0]). Educational attainment, poor marital quality, and spouses’ health and care needs do not predict work exits. Surprisingly, no gender differences are observed. Research on larger survey samples to distinguish different work exit routes and reasons for spouses’ joint work exits appears warranted. To account for cultural and welfare state characteristics, cross-national studies ought to be undertaken.

Background The purpose of this prospective study was to examine the influence of hospital caseload on long-term outcome following standardization of rectal cancer surgery at a national level. Methods Data relating to all 3388 Norwegian patients with rectal cancer treated for cure between November 1993 and December 1999 were recorded in a national database. Treating hospitals were divided into four groups according to their annual caseload: hospitals in group 1 (n = 4) carried out 30 or more procedures, those in group 2 (n = 6) performed 20–29 procedures, group 3 (n = 16) 10–19 procedures and group 4 (n = 28) fewer than ten procedures. Results The 5-year local recurrence rates were 9·2, 14·7, 12·5 and 17·5 per cent (P = 0·003) and 5-year overall survival rates were 64·4, 64·0, 60·8 and 57·8 per cent (P = 0·105) respectively in the four hospital caseload groups. An annual hospital caseload of less than ten procedures increased the risk of local recurrence compared with that in hospitals where 30 or more procedures were performed each year (hazard ratio 1·9 (95 per cent confidence interval (c.i.) 1·3 to 2·7); P < 0·001). Overall survival was lower for patients treated at hospitals with an annual caseload of less than ten versus hospitals with 30 or more (hazard ratio 1·2 (95 per cent c.i. 1·0 to 1·5); P = 0·023). Conclusion The rate of local recurrence was higher for hospitals with a low annual caseload of less than ten procedures than for hospitals with a high treatment volume of 30 or more. Patients treated in small hospitals also had a shorter long-term survival than those treated in large hospitals.

PURPOSE; This study was designed to examine the outcome of cancer of the lower rectum, particularly the rates of local recurrence and survival for tumors located in this area that have been treated by anterior or abdominoperineal resections. METHODS: A prospective, observational, national, cohort study which is part of the Norwegian Rectal Cancer Project. The present cohort includes all patients undergoing total mesorectal excision in 47 hospitals during the period November 1993 to December 1999. A total of 2,136 patients with rectal cancer within 12 cm of the anal verge were analyzed; there were 1,315 (62 percent) anterior resections and 821 (38 percent) abdominoperineal resections. The lower edge of the tumor was located 0 to 5 cm from the anal verge in 791 patients, 6 to 8 cm in 558 patients, and 9 to 12 cm in 787 patients. According to the TNM classification, there were 33 percent Stage 1, 35 percent Stage II, and 32 percent Stage III. RESULTS: Universiate analyses : The five-year local recurrence rate was 15 percent in the lower level, 13 percent in the intermediate level, and 9 percent in the upper level (P = 0.014). It was 10 percent local recurrence after anterior resection and 15 percent after abdominoperineal resection (P = 0.008). The five-year survival rate was 59 percent in the lower level, 62 percent in the intermediate level, and 69 percent in the upper level (P < 0.001), respectively, and it was 68 percent in the anterior-resection group and 55 percent in the abdominoperineal-resection group (P < 0.001). Multivariate analyses: The level of the tumor influenced the risk of local recurrence (hazard ratio 1.8; 95 Percent confidence interval, 1.1-2.3), but the operative procedure, anterior resection vs. abdominoperineal resection, did not (hazard ratio, 1.2; 95 percent confidence interval, 0.7-1.8). On the contrasry, operative procedure influenced survival (hazard ratio, 1.3; 95 percent confidence interval, 1-1.6), but tumor level did not (hazard ratio, 1.1; 95 percent confidence interval, 0.9-1.5). In addition to patient and tumor characteristics (T4 tumors), intraoperative bowel perforation and tumor involvement of the circumferential margin were identified as significant prognostic factors, which were more common in the lower rectum, explaining the inferior prognosis for tumors in this region. CONCLUSIONS: T4 tumors, R1 resections, and/or intraoperative perforation of the tumor or bowel wall are main features of low rectal cancers, causing inferior oncologic outcomes for tumors in this area. If surgery is optimized. preventing intraoperative perforation and involvement of the circumferential resection margin, the prognosis for cancers of the lower rectum seems not to he inherently different from that for tumors at higher levels. In that case, the level of the tumor or the type of resection will not be indicators for selecting patients for radiotherapy.

Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986–88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five-year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level. Methods In 1994, the Norwegian Rectal Cancer Group was founded. The aim of this initiative was to improve the surgical standard by implementing total mesorectal excision (TME) on a national level and to evaluate the results. A number of courses were arranged to teach the surgeons the TME technique, and pathologists were trained to increase the standard of both macroscopic and microscopic assessment of specimens. A rectal cancer registry was established, and all surgical departments treating rectal cancer were invited to transfer their clinical data to this registry. Each department regularly receives its own results together with the national average for comparison and quality control. Results The Rectal Cancer Registry includes all patients with rectal cancer diagnosed since November 1993. From then until December 1999, 5382 patients had a tumour located within 16 cm from the anal verge, and 3432 patients underwent rectal resection with a curative intent. Of these, 9% had adjuvant radiotherapy, and 2% were given chemotherapy. There was a rapid implementation of the new technique, as 78% underwent TME in 1994, increasing to 96% in 1998. After 39 months mean follow-up the rate of local recurrence was 8%, and 5-year overall survival was 71% for patients younger than 75 years. Conclusions An optimized surgical technique (TME) for rectal cancer can reduce the rate of local recurrence and increase overall survival. This improved surgical treatment can be implemented on a national level within a few years. Specialization of surgeons, feedback of results and a separate rectal cancer registry are thought to be major contributors to the improved treatment.

This study analyses the relation between moving during childhood and four different outcomes later in life. We use detailed data on complete cohorts born in Norway between 1965 and 1980 (N=967 151), their parents and siblings, and information on all their moves between Norway's municipalities. We use traditional logistic regression models and sibling fixed-effects models. First, we assess how different outcomes are affected by the number of times a child has moved. Next, we examine whether the child's age at moving is important. The results show that children with more residential relocations during childhood are more likely to drop out of high school, to have low adult income, to experience early parenthood and to die at young age. The sibling fixed-effects models largely confirm this picture. We also found that children who moved prior to elementary school do not have severe long-term outcomes compared with children who did not move at that age, whereas children who moved during teens did have more adverse outcomes than those who did not move at that age.

Background Skin cancer survivors experience an increased risk for subsequent malignancies but the associated risk factors are poorly understood. This study examined the risk of a new primary cancer following an initial skin cancer and assessed risk factors associated with second primary cancers. Methods All invasive cutaneous malignant melanomas (CMM, N = 28 069) and squamous cell carcinomas (SCC, N = 24 620) diagnosed in Norway during 1955–2008 were included. Rates of new primary cancers in skin cancer survivors were compared to rates of primary malignancies in the general population using standardized incidence ratios (SIR). Discrete-time logistic regression models were applied to individual-level data to estimate cancer risk among those with and without a prior skin cancer, accounting for residential region, education, income, parenthood, marital status and parental cancer status, using a 20% random sample of the entire Norwegian population as reference. Further analyses of the skin cancer cohort were undertaken to determine risk factors related to subsequent cancers. Results During follow-up, 9608 new primary cancers occurred after an initial skin cancer. SIR analyses showed 50% and 90% increased risks for any cancer after CMM and SCC, respectively (p

This is the authors’ accepted and refereed manuscript to the article. Publisher's version is available at elsevier.com The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and ii) the use of such treatment improved these patients' survival. 2, Forfatterversjon