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Objectives The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively. Methods The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category. Results Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19. Conclusion Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.

Background: Adult males in Sweden exhibit an increased risk of cancer associated with an increased absorbed dose to the colon from the Chernobyl accident. Methods: A closed cohort, with information on hunter status, included all individuals living in northern Sweden in 1986. Complete annual information on exposure to 137Cs at the dwelling coordinate was available for a total of 2,104,101 individuals. A nested case-control method with four controls matched for year of cancer diagnosis and year of birth, was used. Individual absorbed organ doses were calculated between 1986 and 2020 including external and internal exposure. Hazard ratios (HR) per mGy with 95% confidence intervals (95% CI) were calculated using conditional logistic regression adjusted for rural/nonrural habitat, education level and pre-Chernobyl cancer incidence 1980 to 1985. A total of 161,325 cancer cases in males and 144,439 in females were included. Results: The adjusted HR per mGy for all cancer sites combined was 1.027 (95% CI = 1.022, 1.031) in males and 1.011 (95% CI = 1.006, 1.017) in females. In a post hoc analysis accounting for both remaining confounding from hunter lifestyle and the pre-Chernobyl cancer incidence by county, the adjusted HR per mGy for all cancer sites combined was 1.014 (95% CI = 1.009, 1.019) in males and 1.000 (95% CI = 0.994, 1.006) in females. The post hoc analysis suggested an increased risk of cancer in the colon, pancreas, and stomach, respectively, in males, and lymphoma in females. Conclusions: Increased cancer risk estimates were found for some specific cancer sites but remaining uncontrolled confounding due to hunter lifestyle could not be ruled out.

Bedrock U has been used as a proxy for local indoor radon exposure. A preliminary assessment of cancer incidence rate in a cohort of 809,939 adult males living in 9 different Swedish counties in 1986 has been used to correlate the cumulative lung cancer and total cancer (excluding lung) incidence rates between 1986 and 2020, respectively with the municipality average value of bedrock U concentration obtained from Swedish geological Survey (SGU). To control for regional difference in tobacco smoking, data on county average smoking prevalence, obtained from a survey con-ducted by the Public Health Agency of Sweden from 2001 to 2004, was used. Regression analysis shows that there is a significant positive correlation between smoking prevalence adjusted lung cancer incidence rate in males and the municipality bedrock U concentration (R-2 = 0.273 with a slope 5.0 +/- 0.87.10(-3) ppm(-1)). The correlation is even more significant (R-2 = 0.759 with a slope = 4.8 +/- 0.25,10(-3) ppm(-1)) when assessed on population weighted cancer incidence data binned in nine intervals of municipality average bedrock U concentration (ranging from 0.97 to 4.9 ppm). When assessing the corresponding correlations for total cancer incidence rate (excluding cancer of the lung) with adjustment for smoking prevalence, there appears to be no or little correlation with bedrock U concentra-tion (R-2 = 0.031). We conclude that an expanded future study needs age-standardized cancer incidence data to obtain a more consistent exposure-response model. Such model could be used to predict future lung cancer cases based on geological survey maps of bedrock U as an alternative to laborious indoor radon measurements, and to discern what future lung cancer rates can be expected for a population nearing zero smoking prevalence, with and without radon prevention.

This study aimed to investigate economic self-sufficiency for immigrants, and how health status affected self-sufficiency. The proportion of self-sufficiency during years 1–10 after receiving a residence permit is presented for all non-European labour immigrants (n = 1259) and refugees (n = 23,859), aged 18–54, who immigrated to Sweden 2000–2006, and compared to a control group of Swedish-born (n = 144,745). The risk of not being self-sufficient in year 10 was analysed with Cox regression models, and the results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Moreover, the impact on the self-sufficiency of having a diagnosis from specialised health care during the first five years in Sweden was analysed. The results showed that half of the refugees and three-quarters of the labour immigrants were self-sufficient 10 years after residency. The adjusted risk of not being self-sufficient at year 10 was 80% higher among labour immigrants (HR = 1.8; CI = 1.6–2.0) and more than two-fold among refugees (HR = 2.7; CI = 2.6–2.8) compared to the Swedish-born. Having a diagnosis from specialised health care during the first five years in Sweden had an impact on self-sufficiency in all groups; however, the impact of having a diagnosis did not differ between refugees and Swedish-born. Measures must be taken to increase immigrants’ work participation.

Introduction: Uncertainty in the dose-response of low dose radiation raised concern of an increased cancer incidence in Sweden after the Chernobyl Nuclear Power Plant (NPP) accident. Material and methods: A closed cohort was created of all males >= 18 years of age living in the Northern Sweden in 1986. In total 826,400 individuals were enrolled including 40,874 hunters. A nested case-control design was used with five controls randomly selected for each cancer case matched on year of diagnosis and year of birth. Individual absorbed colon dose was calculated 1986 to 2015. Allowing for a 5-year latency period Hazard Ratios (HR) per mGy with 95% Confidence Intervals (95% CI) were calculated in a conditional logistic regression adjusted by rural/non-rural living, length of education and pre-Chernobyl cancer incidence 1980 to 1985. A total of 127,109 cancer cases occurred from 1 January 1991 to 31 December 2015. Cancer was classified in: 1) Organ-specific (stomach, colon, liver, lung, prostate, urinary bladder, thyroid and leukaemia), 2) Other and 3) Not previously associated to ionizing radiation. Results: The average colon dose in cases was 1.77 mGy compared to controls 1.73 mGy. Hunters average colon dose was 2.32 mGy. Organ-specific cancers showed the highest HR per mGy both in the full cohort, adj HR 1.019 (1.014-1.024) and the hunter subcohort, adj HR 1.014 (1.001-1.027) during follow-up 1991 to 2015. Other cancer and Not previously associated with ionizing radiation showed lower HR per mGy. Therefore, the adj HR per mGy for Total cancer, 1.013 (1.009-1.017) was explained by Organ-specific cancer. Increased adj HR per mGy was seen in stomach, colon and prostate cancer, respectively in the full cohort and lung cancer in hunters. Conclusions: Some cancer sites previously associated with ionizing radiation showed a positive adjusted HR per mGy both in the full cohort and in the hunter subcohort.

Objectives: This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants. Methods: We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991-2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual's highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence. Results: The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21-1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46-1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education. Conclusion: Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals.

In the event of an accidental release of radioactive elements from a nuclear power plant, it has been shown that the radionuclides contributing the most to long-term exposure are Cs-134 and Cs-137. In the case of nuclear power plant fallout, with subsequent intake of radionuclides through the food chain, the internal absorbed dose to target tissues from protracted intake of radionuclides needs to be estimated. Internal contamination from food consumption is not caused by a single intake event; hence, the committed equivalent dose, calculated by a dose coefficient or dose per content function, cannot be easily used to calculate the cumulative absorbed dose to relevant target tissues in the body. In this study, we calculated updated absorbed dose rate coefficients for Cs-134 and Cs-137 based on data from the International Commission on Radiological Protection (ICRP) on specific absorbed fractions. The absorbed dose rate coefficients are provided for male and female adult reference phantoms, respectively, assuming a steady-state distribution of Cs that we calculated from the ICRP biokinetic model for Cs. With these coefficients, the absorbed dose to the listed target tissues, separately and to the total body, are related to the number of nuclear transitions (time-integrated activity) in each listed source region. Our new absorbed dose rate coefficients are given for the complete set of target tissues and have not been presented before. They are also provided for aggregated categories of organs to facilitate epidemiological studies., Title from Web of Science: Absorbed dose rate coefficients for Cs-134 and Cs-137 with steady-state distribution in the human body: S-coefficients revisited

The effect of age and gender in risk estimates related to long-term residence in areas contaminated by nuclear power plant fallout was evaluated by applying the lifetime attributable risk (LAR) concept to an existing exposure model that was previously used for cumulative effective dose estimates. In this study, we investigated the influence of age distribution on the number of cancer cases by applying five different age distributions from nuclear power-producing countries (India, Japan, South Korea, and the United States), and Egypt because of intentions to develop nuclear power. The model was also used to estimate the effective dose and gender-specific LAR as a function of time after fallout for the offspring of the population living in Cs-137 fallout areas. The principal findings of this study are that the LAR of cancer incidence (excluding non-fatal skin cancers) over 70 y is about 4.5 times higher for newborn females (5.4% per MBq m(-2) of initial Cs-137 ground deposition) than the corresponding values for 30 y old women (1.2% per MBq m(-2) Cs-137 deposition). The cumulative LAR for newborn males is more than 3 times higher (3.2% versus 1.0% per MBq m(-2) Cs-137 deposition). The model predicts a generally higher LAR for women until 50 y of age, after which the gender difference converges. Furthermore, the detriment for newborns in the fallout areas initially decreases rapidly (about threefold during the first decade) and then decreases gradually with an approximate half-time of 10-12 y after the first decade. The age distribution of the exposed cohort has a decisive impact on the average risk estimates, and in our model, these are up to about 65% higher in countries with high birth rates compared to low birth rates. This trend implies larger average lifetime attributable risks in countries with a highly proportional younger population. In conclusion, the large dispersion (up to a factor of 4 between newborns and 30 y olds) in the lifetime detriment per unit grou

The time-integrated absorbed dose to the thyroid gland in the years after a fallout event can indicate the potential excess number of thyroid cancers among young individuals after a radionuclide release. Typical mean values of the absorbed dose to the thyroid have been calculated previously using reported data on radioiodine obtained from air sampling and dairy milk surveys in Sweden after the Chernobyl fallout, not including the contribution from Cs-134 and Cs-137. We have developed a model for Swedish conditions taking these additional dose contributions into account. Our estimate of the average time-integrated absorbed dose to the thyroid, D-th,D-tot, during the first 5 years after fallout ranged from 0.5-4.1 mGy for infants and from 0.3-3.3 mGy for adults. The contribution to D-th,D-tot, from I-131 through inhalation and milk consumption varied considerably among different regions of Sweden, ranging from 9%-79% in infants, and from 4%-58% in adults. The external irradiation and exposure from the ingestion of (CS)-C-134,137 in foodstuffs accounted for the remaining contributions to D-th,D-tot, (i.e. up to 96% for adults). These large variations can be explained by the highly diverse conditions in the regions studied, such as different degrees of fractionation between wet and dry deposition, different grazing restrictions on dairy cattle, and differences in (CS)-C-134,137 transfers through food resulting from differences in the local fallout. It is our conclusion that the main contribution to D-th,D-tot, from nuclear power plant fallout in areas subjected to predominantly wet deposition will be from external exposure from ground deposition, followed by internal exposure from contaminated food containing the long-lived fission product Cs-137 and the neutron-activated fission product (CS)-C-134. The contribution from (CS)-C-134,137 to the thyroid absorbed dose should thus be taken into account in future epidemiological studies., Correction in: JOURNAL OF RADIOLOGICAL PROTECTION, Volume: 39, Issue: 3, Pages: 987-989, DOI: 10.1088/1361-6498/ab21ea

The radiological consequences of a nuclear power plant (NPP) accident, resulting in the release of radionuclides to the environment, will depend largely on the mitigating actions instigated shortly after the accident. It is therefore important to make predictions of the radiation dose to the affected population, from external as well as internal exposure, soon after an accident, despite the fact that data are scarce. The aim of this study was to develop a model for the prediction of the cumulative effective dose up to 84 years of age based on the ground deposition of Cs-137 that is determined soon after fallout. The model accounts for different assumptions regarding external and internal dose contributions, and the model parameters in this study were chosen to reflect various mitigating actions. Furthermore, the relative importance of these parameters was determined by sensitivity analysis. To the best of our knowledge, this model is unique as it allows quantification of both the external and the internal effective dose using only a fallout map of Cs-137 after a nuclear power plant accident. The cumulative effective dose over a period of 50 years following the accident per unit Cs-137 deposited was found to range from 0.14 mSv/kBq m(-2) to 1.5 mSv/kBq m(-2), depending on the mitigating actions undertaken. According to the sensitivity analysis, the most important parameters governing the cumulative effective dose to various adult populations during 50 years after the fallout appear to be: the correlation factor between the local areal deposition of Cs-137 and the maximum initial ambient dose rate; the maximum transfer from regional average fallout on the ground to body burden; the local areal deposition of Cs-137; and the regional average Cs-137 deposition. Therefore, it is important that mapping of local Cs-137 deposition is carried out immediately after fallout from a nuclear power plant accident, followed by calculations of radiation doses for different scenarios

After the Chernobyl Nuclear Power Plant accident 137Cs was deposited in Mid-Sweden, with the highest activity in Gävle municipality. We compared aerial measurements of 137Cs on the ground over time in Gävle municipality since 1986. Maps of soil types and land use were used to analyse the decrease in activity of 137Cs. A spatial pattern was identified where the reduction of activity was greater in sand than in organic soil. For land use the reduction was greater in urban areas than in forests, with agricultural land in between. Long-term external radiation from 137Cs depends not only on the physical decay of 137Cs but also indirectly on geology, and this should be considered when calculating external radiation doses to individuals in epidemiological studies.