Alfredsson L
Acta Med Scand Suppl. 1985;698:1-24.
In the present thesis methods for utilizing some of the many registers in Sweden for epidemiological purposes were further developed. These purposes include immigrant studies, case-control studies dealing with psychosocial job characteristics, and studies of time trends. A theoretical framework for handling problems of misclassification when using register data was developed. Register data were used to examine several hypotheses concerning the occurrence and etiology of myocardial infarction (MI). The result of these all emphasize the role of environmental factors in the etiology of MI. Further information on the relationship between migration and MI was obtained. Male Finnish immigrants in Sweden tend to adopt the lower risk of native Swedes. This implies that environmental factors are important in explaining the difference in incidence of MI between Finland and Sweden. This also implies that it may be possible to decrease the risk by changing environmental conditions. The relationship between psychosocial work environment and MI risk was studied in a new way by using information on occupation. Occupations characterized by hectic work and at the same time providing little possibility for control or growth were significantly associated with an elevated MI risk. The risk for men aged 40-54 years employed in these strenuous occupations was about twice as high as for those in other occupations. This result remained relatively unaffected when several potential confounding factors were taken into consideration. A study was undertaken to examine trends in the incidence and mortality of MI in Stockholm (1974-80). For men the incidence as well as the mortality was appreciably increased. For women there was an appreciable increase in incidence while the increase in mortality was more uncertain. The observed increases in incidence and mortality are contrary to the trend for most other nations in the Western hemisphere. The reason for the increasing trend in Stockholm is, however, unknown.
在本论文中，对瑞典众多登记资料用于流行病学目的的方法进行了进一步开发。这些目的包括移民研究、涉及心理社会工作特征的病例对照研究以及时间趋势研究。构建了一个用于处理使用登记资料时误分类问题的理论框架。登记资料被用于检验若干关于心肌梗死（MI）发生和病因的假设。所有这些研究结果均强调了环境因素在MI病因中的作用。获得了关于移民与MI之间关系的更多信息。瑞典的芬兰男性移民往往呈现出与瑞典本土人较低的风险水平。这意味着环境因素对于解释芬兰和瑞典之间MI发病率的差异很重要。这也意味着通过改变环境条件有可能降低风险。通过使用职业信息，以一种新的方式研究了心理社会工作环境与MI风险之间的关系。以工作繁忙且同时几乎没有控制或成长可能性为特征的职业与MI风险升高显著相关。从事这些高强度职业的40 - 54岁男性的风险大约是从事其他职业男性的两倍。在考虑了若干潜在混杂因素后，这一结果相对未受影响。开展了一项研究以考察斯德哥尔摩地区MI发病率和死亡率的趋势（1974 - 1980年）。对于男性而言，发病率和死亡率均显著上升。对于女性，发病率显著上升，而死亡率的上升则更不确定。观察到的发病率和死亡率上升与西半球大多数其他国家的趋势相反。然而，斯德哥尔摩地区这种上升趋势的原因尚不清楚。
