European Journal of Epidemiology最新文献

{"title":"All-cause and cause-specific mortality in individuals with COPD in China: a 16-year follow-up cohort study.","authors":"Yalei Ke, Yuxuan Zhao, Dianjianyi Sun, Pei Pei, Huaidong Du, Yiping Chen, Ling Yang, Xiaoming Yang, Yalin Chen, Junshi Chen, Zhengming Chen, Jun Lv, Liming Li, Canqing Yu","doi":"10.1007/s10654-025-01252-7","DOIUrl":"10.1007/s10654-025-01252-7","url":null,"abstract":"<p><p>The prevalence of chronic obstructive pulmonary disease (COPD) is rising in China, yet population-based evidence on COPD-related mortality risk remains limited. This study examined the association between prevalent COPD and all-cause and cause-specific mortality in a large Chinese cohort. 484,301 adults aged 30 to 79 years who received spirometry at the baseline of the China Kadoorie Biobank Study (2004-2008) were included. COPD was defined as FEV₁/ FVC < 0.7. Mortality data were tracked via local death registries and national health insurance systems over a median follow-up period of 16.0 years. Cox proportional hazard models and competing risk regression were used to estimate hazard ratios (HRs) and subdistribution HRs (SHRs), respectively. The COPD group had higher all-cause and cause-specific mortality, with adjusted HR (95%CI) for all-cause mortality of 1.44 (1.41-1.47), and adjusted SHR (95%CI) of 1.09 (1.05-1.13), 1.06 (1.01-1.11), 3.30 (3.12-3.49), 1.45 (1.16-1.81), for circulatory disease, neoplasms, respiratory disease, and infectious disease mortality, respectively. Specifically, young COPD (aged < 50 years) showed a stronger mortality association than those aged ≥ 50 years. Moreover, individuals with preserved ratio impaired spirometry (PRISm) had a 1.4-fold higher risk of all-cause mortality compared with non-COPD participants. COPD is associated with a significantly elevated risk of mortality from all causes, circulatory disease, neoplasms, respiratory disease, and infectious disease in the Chinese population. Additionally, young COPD and those with PRISm faced significant mortality burdens.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"681-691"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal and childhood infections and risk of epilepsy.","authors":"Yi-Jiun Pan, Mei-Chen Lin, Chi-Fung Cheng, Chi-Shin Wu, Chia-Lin Liu, Pei-Chun Chen, Wesley K Thompson, Chun-Chieh Fan, Shi-Heng Wang","doi":"10.1007/s10654-025-01256-3","DOIUrl":"10.1007/s10654-025-01256-3","url":null,"abstract":"<p><p>Infections in utero and early childhood are associated with an increased epilepsy risk; however, confounding by familial predisposition has not been adequately accounted for in previous studies. We aimed to assess the epilepsy risk attributable to infections in utero and early childhood by performing population-based and sibling-comparison analyses to account for residual and unmeasured familial confounding factors. This nationwide birth cohort study included 2,609,289 individuals born 2001-2016 in Taiwan. Maternal infection during pregnancy and early childhood infection during the first year of life were defined. Maternal pre-pregnancy infection was used as negative control. In the population analyses, offspring exposed to any maternal infection during pregnancy had an increased epilepsy risk (hazard ratio (HR) = 1.36, 95% confidence interval (CI):1.27-1.45). However, the association with maternal infection was attenuated to the null (HR = 1.11, 95% CI:0.98-1.27), except for maternal infection in sepsis (HR = 2.54, 95% CI:1.74-3.70) and central nervous system (HR = 24.59, 95% CI:3.28-184.23), in the sibling analyses. The association of maternal pre-pregnancy infection with offspring epilepsy was observed in the population analyses, but not in the sibling analyses. Individuals exposed to childhood infection had an increased epilepsy risk (HR = 1.49, 95% CI:1.45-1.54) in the population analyses; the association was still observed in the sibling analyses (HR = 1.31, 95% CI:1.23-1.40). The association between maternal infection during pregnancy and epilepsy risk in the offspring appears largely because of familial confounding factors. Infections during early childhood may play a causal role in the subsequent epilepsy risk.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"693-704"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-linear Mendelian randomization: evaluation of effect modification in the residual and doubly-ranked methods with simulated and empirical examples.","authors":"Fergus W Hamilton, David A Hughes, Tianyuan Lu, Zoltán Kutalik, Apostolos Gkatzionis, Kate Tilling, Fernando P Hartwig, George Davey Smith","doi":"10.1007/s10654-025-01208-x","DOIUrl":"10.1007/s10654-025-01208-x","url":null,"abstract":"<p><p>Non-linear Mendelian randomisation (NLMR) is a relatively recently developed approach to estimate the causal effect of an exposure on an outcome where this is expected to be non-linear. Two commonly used techniques-based on stratifying the exposure and performing Mendelian randomisation (MR) within each strata-are the residual and doubly-ranked methods. The residual method is known to be biased in the presence of genetic effect heterogeneity-where the effect of the genotype on the exposure varies between individuals. The doubly-ranked method is considered to be less sensitive to genetic effect heterogeneity. In this paper, we simulate genetic effect heterogeneity and confounding of the exposure and outcome and identify that both methods are susceptible to likely unpredictable bias in this setting. Using UK Biobank, we identify empirical evidence of genetic effect heterogeneity and show via simulated outcomes that this leads to biased MR estimates within strata, whilst conventional MR across the full sample remains unbiased. We suggest that these biases are highly likely to be present in other empirical NLMR analyses using these methods and urge caution in current usage. Simulated outcome analyses may represent a useful test to identify if genetic effect heterogeneity is likely to bias NLMR estimates in future analyses.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"631-647"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postdiagnosis physical activity and dietary inflammatory and insulinemic potential with overall survival in men with nonmetastatic prostate cancer.","authors":"Dong Hoon Lee, Leandro F M Rezende, Gerson Ferrari, Yiwen Zhang, Qiao-Li Wang, Hannah Oh, NaNa Keum, Jinbo Hu, Justin Y Jeon, Lorelei A Mucci, Edward L Giovannucci","doi":"10.1007/s10654-025-01240-x","DOIUrl":"10.1007/s10654-025-01240-x","url":null,"abstract":"<p><p>Inflammation and insulin resistance are associated with increased mortality in the general population. However, it remains unclear how physical activity and proinflammatory/hyperinsulinemic diets influence overall survival in prostate cancer patients. We analyzed 4779 men with nonmetastatic prostate cancer from the Health Professionals Follow-up Study. Postdiagnosis physical activity and diet were assessed using validated self-reported questionnaires. We used the validated dietary scores to empirically assess the anti-inflammatory (rEDIP) and anti-insulinemic (rEDIH) potential of dietary patterns based upon specific combinations of food groups. Cox regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median of 15 years of follow-up, we identified 2282 deaths. Compared to men with < 3 MET-h/week of postdiagnosis physical activity, multivariable-adjusted HRs (95% CI) were 0.80 (0.68-0.95) for 9-< 24 MET-h/week, 0.63 (0.53-0.75) for 24-< 48 MET-hours/week and 0.61 (0.51-0.73) for ≥ 48 MET-hours/week in relation to all-cause mortality (P-trend < 0.001). Both vigorous and non-vigorous activities after diagnosis were associated with lower all-cause mortality (P-trend < 0.001). Moreover, post-diagnosis rEDIP and rEDIH scores were inversely associated with all-cause mortality (HR per 1-SD increase: 0.93 (0.89-0.99) for rEDIP; 0.91 (0.86-0.96) for rEDIH). In joint analyses, men with high physical activity and high rEDIP (or rEDIH) score showed approximately 30-36% lower risks of all-cause mortality, compared to those with low physical activity and low diet scores. In conclusion, high physical activity and low proinflammatory and hyperinsulinemic diets were independently associated with decreased risk of all-cause mortality in men with prostate cancer. Men with both high physical activity and low proinflammatory and hyperinsulinemic diets after diagnosis have the lowest mortality rate.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"669-679"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer risk after in utero exposure to diethylstilbestrol.","authors":"Naomi B Boekel, Janneke Verloop, Hester H van Boven, Elisabeth J M van Erp, Lieske Schrijver, Matti A Rookus, Flora E van Leeuwen","doi":"10.1007/s10654-025-01234-9","DOIUrl":"10.1007/s10654-025-01234-9","url":null,"abstract":"<p><p>In utero exposure to diethylstilbestrol (DES) is associated with increased risk of clear cell adenocarcinoma (CCAC) of the vagina or cervix. It is not clear whether these risks remain increased at older ages, and if the risks of other cancer sites, including breast cancer, are increased. This nationwide cohort study included 12,249 DES-exposed women and 2,070 unexposed sisters. Hormone-related risk factors and medical history were assessed through questionnaires, and cancer incidence through linkages with nationwide registries. Comparison with general population rates showed no difference in overall cancer risk (SIR = 0.98, 95%CI 0.93-1.04) or breast cancer risk (SIR = 1.03, 95%CI 0.96-1.11) for DES-exposed women. The rate of vaginal cancer was strongly increased for DES-exposed women (SIR = 10.5, 95%CI 5.72-17.6) and was increased in all age categories, including age 60-69 years (SIR = 8.3, 95%CI 1.00-29.9). Risks of both CCAC (SIR = 49.1, 95%CI 21.2-96.8) and squamous cell carcinoma (SCC; SIR = 5.86, 95%CI 2.15-12.8) of the vagina were significantly elevated. When comparing DES-exposed women with DES-unexposed sisters, overall cancer risk and risk of breast cancer were similar (HR = 0.93, 95%CI 0.78-1.11 and HR = 0.97, 95%CI 0.76-1.23, respectively). Apart from the established increased risk of vaginal cancer, women exposed to DES in utero do not seem to be at increased risk of cancer, including breast cancer. The risk of vaginal cancer remains increased also for women in their fifties/sixties. Moreover, the increased risk of vaginal cancer was seen for both subtypes CCAC and SCC. Screening for vaginal cancer up to higher ages than currently recommended (< 60 years) should be considered.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"659-668"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Search for common genetic variants to allow reliable Mendelian randomization investigations into ketone metabolism.","authors":"Zhu Liduzi Jiesisibieke, Héléne Toinét Cronjé, C Mary Schooling, Stephen Burgess","doi":"10.1007/s10654-025-01246-5","DOIUrl":"10.1007/s10654-025-01246-5","url":null,"abstract":"<p><p>Ketogenic diets are popular among people aiming for weight management. Ketone supplementation has been linked to improved cognitive performance and increased risk of insulin resistance. We aim to identify common genetic variants that allow Mendelian randomization investigations into further potential effects of ketone metabolism. We set four premises that we believe any valid instrument for ketone metabolism should satisfy. These are: (1) location in a gene region relevant to ketone metabolism, (2) association with all three primary ketone bodies (acetone, acetoacetate, and beta-hydroxybutyrate), (3) no pleiotropic associations, (4) associations with positive control variables (cognitive performance, two-hour glucose, and insulin fold change). We considered gene regions containing variants previously associated with acetone. Four of these regions had biological relevance to ketone metabolism. Lead variants for three of these four regions (SLC2A4, HMGCS2, OXCT1) were associated with all three primary ketone bodies. One region (SLC2A4) was associated with two-hour glucose and insulin fold change; however, this region had strong pleiotropic associations with blood pressure. One region (OXCT1) showed an association with cognitive performance, and thus satisfied all our premises to be a valid instrument for ketone metabolism. In a complementary agnostic approach considering all genome-wide significant predictors of the three primary ketone bodies in turn, genetically predicted acetoacetate based on seven variants was associated with improved cognitive performance. However, several variants selected in this approach were not located in biologically relevant gene regions and were pleiotropic. Causal claims from Mendelian randomization will be most reliable when the instrumental variable assumptions are plausibly satisfied. We illustrate a framework to identify candidate instruments based on biological considerations.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"649-657"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin use and risk of nonalcoholic fatty liver disease.","authors":"Shih-Wei Lai, Kuan-Fu Liao","doi":"10.1007/s10654-025-01257-2","DOIUrl":"10.1007/s10654-025-01257-2","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"735-736"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cohort profile: Copenhagen Hospital Biobank-chronic inflammatory disease-inflammatory bowel disease (CHB-CID:IBD) genetic cohort.","authors":"Behrooz Darbani, Thorsten Brodersen, Anette Liljensøe, Signe Bek Sørensen, Josephine Bjergbæk Olsson-Svendsen, Alfonso Buil, Ahmed Kamal, Andrew J Schork, Anja Poulsen, Bertram Dalskov Kjerulff, Bitten Aagaard, Britta Ørnfelt Lund, Charlotte Siggaard Rittig, Christina Mikkelsen, Daniel Millencourt Larsen, David Westergaard, Ditte Rudbeck-Resdal, Dorte Helenius Mikkelsen, Else Randers, Frank Vinholt Schiødt, Hans Jürgen Hoffmann, Isabella Friis Jørgensen, Ivan Brandslund, Jacob Broder Brodersen, Jakob Hjorth von Stemann, Jakob Thaning Bay, Janna Nissen, Jeanette Sørensen, Jens Kjærgaard Boldsen, Joseph Dowsett, Josephine Gladov, Karina Banasik, Kathrine Agergård Kaspersen, Katrine Carlsen, Khoa Manh Dinh, Lauge Kellermann, Lea Arregui Nordahl Christoffersen, Liam James Elgaard Quinn, Lise Wegner Thørner, Lone Larsen, Luise Aamann, Malene Rohr Andersen, Maria Didriksen, Maria Joanna Alexandraki, Marianne Kragh Thomsen, Mette Julsgaard, Mette Nyegaard, Michael Schwinn, Mie Topholm-Bruun, Mikael Njai Leite, Morten Lee Halling, Natalia Pedersen, Ole K Bonderup, Palle Duun Rohde, Pernille Dige Ovesen, Ram Benny Dessau, Sanaz Saboori, Sofie Holm-Christensen, Steffen Bank, Susan Mikkelsen, Thomas Folkmann Hansen, Thomas Werge, Niels Qvist, Erik Sørensen, Johan Burisch, Merete Lund Hetland, Bente Glintborg, Christian Erikstrup, Søren Brunak, Henrik Ullum, Sisse Rye Ostrowski, Ole Birger Vesterager Pedersen, Vibeke Andersen","doi":"10.1007/s10654-025-01239-4","DOIUrl":"10.1007/s10654-025-01239-4","url":null,"abstract":"<p><p>The Copenhagen Hospital Biobank-chronic inflammatory disease-inflammatory bowel disease (CHB-CID: IBD) cohort contributes to genetic research in inflammatory bowel disease, including Crohn's disease and ulcerative colitis. Of the 327,084 enrolled and genotyped individuals in the cohort, 10,626 have been diagnosed with IBD as of May 2023. The CHB-CID: IBD cohort includes both patients without IBD and healthy blood donors as control groups. Clinical data is collected from Danish registries and patient records, including details on hospital contacts, co-morbidities, medication, surgical procedures, and laboratory investigations. The cohort features a wide age range (> 18 years), extensive population coverage representative of Danish adults, and validated IBD diagnoses. Finally, the cohort benefits from continuous recruitment and regular updates of clinical information. The aim is to enhance IBD management and ultimately improve patients' quality of life.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":"721-734"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in LDL-cholesterol levels following aromatase inhibitor treatment in early postmenopausal breast cancer.","authors":"Marie Lund,Giulia Corn,Maj-Britt Jensen,Tonny Petersen,Kim Dalhoff,Bent Ejlertsen,Lars Køber,Jan Wohlfahrt,Mads Melbye","doi":"10.1007/s10654-025-01228-7","DOIUrl":"https://doi.org/10.1007/s10654-025-01228-7","url":null,"abstract":"There is an unsettled concern that treatment with aromatase inhibitors (AIT) may adversely affect lipid-levels. In light of the improved survival of women with breast cancer and increased risk of atherosclerotic cardiovascular disease in older people, unfavorable effects on lipid-levels may represent a significant health concern for this group of patients. We used linked data from nationwide registries, including a clinical breast cancer database with information about allocated and dispensed AIT. Based on these, we investigated changes in plasma lipid-levels (primary outcome: low-density lipoprotein (LDL)-cholesterol, secondary outcomes: high-density lipoprotein (HDL)-cholesterol, total cholesterol, and triglycerides) following AIT in a nationwide cohort of postmenopausal women with early breast cancer, Denmark, 2009-2020. Included women had at least one LDL-cholesterol measurement before and after breast cancer diagnosis. Exposure was allocated and dispensed AIT as compared with not allocated to and no dispensed AIT. Outcome was the adjusted difference in lipid-level-change (from before to after breast cancer diagnosis) according to AIT. Among 10,461 women, there were 22,693 pre-breast cancer LDL-cholesterol measurements and 42,750 post-breast cancer LDL-cholesterol measurements. Overall, 7919 of the women were exposed to AIT and 2542 women were unexposed. For AIT exposed, the LDL-cholesterol-change was - 0.16 mmol/L (mM), and for unexposed, - 0.15 mM, respectively. The corresponding adjusted difference in LDL-cholesterol change for AIT exposed versus unexposed was - 0.03 mM (95% CI - 0.07 to 0.003). We found similar results in analysis of secondary outcomes. This study does not support the concern that AIT adversely affects lipid-levels.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"1 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The healthcare system in Sweden","authors":"Jonas F. Ludvigsson, David Bergman, Catharina Ihre Lundgren, Kristina Sundquist, Jean-Luc af Geijerstam, Anna H. Glenngård, Marie Lindh, Johan Sundström, Johan Kaarme, Jialu Yao","doi":"10.1007/s10654-025-01226-9","DOIUrl":"https://doi.org/10.1007/s10654-025-01226-9","url":null,"abstract":"<p>The Swedish population is characterized by high life expectancy and low avoidable mortality rates. This review outlines the Swedish healthcare system, which offers universal access to all residents and has a long tradition of reforms for social equity. Responsibility for healthcare is shared between the state, the regions, and the municipalities. The Ministry of Health and Social Affairs provides the overall healthcare framework; additionally, several governmental agencies are directly involved in healthcare and public health initiatives. The 21 regions organize, finance, and provide most primary, secondary, and tertiary care, as well as health information channels. Resources for primary care are less plentiful than in many other countries. The 290 municipalities deliver care to elderly people and those with functional impairment. The Swedish healthcare system is primarily tax-funded, with 86% of total healthcare expenditures from public expenses and &lt; 1% from voluntary health insurance. The gross domestic product (GDP) share of healthcare expenditures, 10.5% in 2022, is above the EU average. The level of unmet needs in the population is low, due to universal coverage and caps on user charges except for dental care. Sweden’s healthcare system performs well on care quality and patient satisfaction, but suffers from workforce shortage and care fragmentation. Limitations in care coordination can be attributed to a siloed digital infrastructure and care governance, a low number of hospital beds per capita, and a compensation system that often does not incentivize coordination. Despite these challenges, life expectancy is high and avoidable mortality rates are low in Sweden.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"121 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}