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Hui Xin WangProfessor

Om mig

Mina primära forskningsområde är epidemiologi med inriktning mot dels neurodegenerativa sjukdomar hos äldre, dels kardiovaskulär sjukdom i medelåldern. Mina specifik forskningsintressen är: (1) hur livsstil (rökning, intag av vitamin B12 och folsyra, sociala nätverk och fritidsaktivitet) och psykosociala faktorer (personlighet, arbetsstress, och faktorer som förstärker den kognitiva reserven över livsloppet) interagerar med genetiska faktorer för att påverka risken för demens, kognitivt förfall, metabolisk ohälsa, depression och dödlighet; och (2) hur psykosociala faktorer (socialt stöd, arbetsstress, och depressiva symptom) påverkar progressionen av kranskärlsjukdomar.”


Utvalda publikationer​

Wang H-X, MacDonald S.W.S. Dekhtyar S, Fratiglioni L. Association of life-long exposure to cognitive reserve-enhancing factors with dementia risk. PLOS Med. March 14, 2017.

Rizzuto D, Mossello E, Fratiglioni L, Santoni G, Wang H-X. Personality and survival in older age: the role of lifestyle and health status. Am J Geriatri Psychiatry. DOI:

Pan K-Y*, Xu W, Mangialasche M, Fratiglioni L, Wang H-X*. Work-related psychosocial stress and the risk of type 2 diabetes. J Intern Med. 2017 Apr 24. 281(6):601-610.

Gerritsen L, Kalpouzos G, Westman E, Simmons A, Wahlund L-O, Bäckman L, Fratiglioni L, Wang H-X. The influence of negative life events on hippocampal and amygdala volumes in old age: A life-course perspective. Psychol Med. 2015 Apr;45(6):1219-28.

Hahn EA, Wang H-X*, Andel R, Fratiglioni L. A Change in Sleep Pattern May Predict Alzheimer’s disease. Am J Geriatr Psychiatry. 2014 Nov;22(11):1262-71.

Wang H-X, Jin Y, Hendrie HC, Liang C, Yang L, Cheng Y, Unverzagt FW, Ma F, Hall HS, Murrell JR, Li P, Bian J, Pei J-J, Gao S. Late life leisure activities and risk of cognitive decline. J Gerontol A Biol Sci Med Sci. 2013;68(2):205-13

Wang H-X, Gustafson D, Kivipelto M, Pedersen N.L., Skoog I, Windblad B, Fratiglioni L. Education halves the risk of dementia due to apolipoprotein ε4 allele. Neurol Aging 2012;33(5):1007.e1-7.

Wang H-X, Wahlberg M, Karp A, Winblad B, Fratiglioni L. Psychosocial stress at work is associated with increased dementia risk in late life. Alzheimer’s & Dementia 2012;8:114-120.

Rydwik E, Welmer A-K, Angleman S, Fratiglioni L, Wang H-X. Is midlife occupational physical activity related to disability in old age? PLoS ONE 2013;8(7):e70471. doi: 10.1371/journal.pone.0070471

Paillard-Borg S, Fratiglioni L, Xu W, Winblad B, Wang H-X. An active lifestyle postpones dementia onset by more than one year in very old adutls. J Alzheimers Dis. 2012;31(4):835-42.

Wang H-X, Karp A, Herlitz A, Crowe M, Kåreholt I, Winblad B, Fratiglioni L. Personality and lifestyle in relation to dementia incidence. Neurology 2009;72:253-259.

Wang H-X, Mittleman MA, Leineweber C, Orth-Gomer K. Depressive symptoms in combination with social isolation hastens progression of coronary artery atherosclerosis in middle-aged women.Psychother Psychosom 2006:75;96-102.

Wang H-X, Mittleman MA, Orth-Gomer K. Influence of social support on progression of coronary artery disease in women. Soc Sci Med 2005;60:599-607.

Wang H-X, Karp A, Winblad B, Fratiglioni L. Late-life engagement in social and leisure activities is associated with a decreased risk of dementia. Am J Epidemiol 2002;155:1081-7.

Wang H-X, Wahlin Å, Basun H, Fastbom J, Winblad B, Fratiglioni L. Low levels of vitamin B12 and folate and Alzheimer’s disease incidence. Neurology 2001;56:1188-94.

Fratiglioni L, Wang H-X, Maytan M, Ericsson K, Winblad B. The Influence of Social Network on the Occurrence of Dementia. Lancet 2000;355:1315-9.

Wang H-X, Fratiglioni L, Frisoni GB, Viitanen M, Winblad B. Smoking and the occurrence of Alzheimer’s disease. Am J Epidemiol1999;149:640-4.



I urval från Stockholms universitets publikationsdatabas

  • The Implication of Physically Demanding and Hazardous Work on Retirement Timing

    2022. Johanna Stengård (et al.). International Journal of Environmental Research and Public Health 19 (13)


    The need to retain individuals longer in the workforce is acknowledged in many high-income countries. The present study therefore aimed to examine the importance of physically demanding work tasks (PDWT) and physically hazardous work environment (PHWE) in relation to retirement timing among pensionable workers (≥61 years). A particular question was whether PDWT and PHWE increased in importance with age. Six waves (2008–2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (n = 5201; 56% women and 44% men; mean age at first survey was 61.0 (SD 2.0) years). Discrete time-event history analysis, stratified by socioeconomic position and gender, showed that among blue-collar workers, PDWT and PHWE were associated with an increased likelihood of retiring within the next two years. With increasing age, high-level PHWE was associated with higher probability of retiring among blue-collar men, whereas heavy PDWT was associated with lower probability of retiring among blue-collar women. Among white-collar workers, having at least some PDWT compared to no PDWT was associated with a lower likelihood of retiring within the next two years. With increasing age, exposure to PHWE was associated with higher probability of retiring among white-collar women. These results suggest that to delay retirements, organizations could offer their older employees, especially blue-collar workers and the oldest white-collar women, alternatives to PDWT and PHWE.

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  • Sleep Mediates the Association Between Stress at Work and Incident Dementia: Study From the Survey of Health, Ageing and Retirement in Europe

    2022. Xiao Tan (et al.). The journals of gerontology. Series A, Biological sciences and medical sciences


    Background: Both psychosocial stress at work and sleep disturbance may predispose impaired cognitive function and dementia in later life. However, whether sleep plays a mediating role for the link between stress at work and subsequent dementia has yet to be investigated.

    Methods: Data from the Survey of Health, Ageing and Retirement in Europe were used for the study. A cohort of 7 799 dementia-free individuals (aged 71.1 ± 0.2 years) were followed up for a median of 4.1 years for incident dementia. Job demand and control were estimated using questions derived from the Karasek’s Job Content Questionnaire. Sleep disturbance was ascertained by a question in the EURO-Depression scale. Cox proportional hazard models adjusted for age, sex, education, cognitive test score, and other potential covariates were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia in relation to different job strain levels.

    Results: An interaction between job demand and sleep disturbance regarding the risk of dementia was detected. Data suggested a protective role of high-level job demand for dementia in individuals with sleep disturbance (HR [95% CI]: 0.69 [0.47, 1.00]) compared with low job demand. A 4-category job strain model based on the combination of job demand and job control levels suggested that among individuals with sleep disturbance, passive job (low demand, low control) was associated with a higher risk of dementia (1.54 [1.01, 2.34]), compared to active job (high demand, high control).

    Conclusion: The link between work-related stress and risk of dementia is limited to individuals suffering sleep disturbance.

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  • Do good psychosocial working conditions prolong working lives?

    2021. Johanna Stengård (et al.). European Journal of Ageing


    Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006-2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N = 6000, observations = 10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06-1.22], skill use [OR 1.17, 95% CI 1.07-1.29], learning opportunities [OR 1.22, 95% CI 1.13-1.31], social support [OR 1.29 (95% CI 1.16-1.42], work-time control [OR 1.07, 95% CI 1.01-1.13], and reward [OR 1.40, 95% CI 1.24-1.57])-but not lower levels of job demands (quantitative and emotional demands or effort)-were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73-0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.

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  • Sex differences in dementia and response to a lifestyle intervention

    2021. Shireen Sindi (et al.). Alzheimer's & Dementia 17 (7), 1166-1178


    Introduction: Evidence on sex differences in the risk for dementia has been mixed. The goal was to assess sex differences in the development of dementia, and in the effects of a lifestyle intervention.

    Methods: Two strategies were adopted, one using combined data from three large Nordic population-based cohort studies (n = 2289), adopting dementia as outcome, and 2-year multidomain lifestyle intervention (n = 1260), adopting cognitive change as outcome.

    Results: There was higher risk for dementia after age 80 years in women. The positive effects of the lifestyle intervention on cognition did not significantly differ between men and women. Sex-specific analyses suggested that different vascular, lifestyle, and psychosocial risk factors are important for women and men in mid- and late-life.

    Conclusion: Women had higher risk for dementia among the oldest individuals. Lifestyle interventions may be effectively implemented among older men and women.

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  • Shared risk and protective factors between Alzheimer's disease and ischemic stroke

    2021. Rui Wang (et al.). Alzheimer's & Dementia 17 (2), 191-204


    Introduction: Stroke, especially ischemic stroke's (IS) link with Alzheimer's disease (AD) remains unclear.

    Methods: This prospective cohort study included 2459 AD‐ and cerebrovascular disease‐free older adults at baseline (mean age 71.9 ± 10.3 years, Stockholm, Sweden). Using Cox regressions, shared risk factors (SRFs) and shared protective factors (SPFs) between AD and IS were recognized when their hazard ratios in both AD and IS models were significant and in the same direction.

    Results: During the follow‐up period of up to 15 years, 132 AD and 260 IS mutually exclusive cases were identified. SRFs were low education, sedentary lifestyle, and heart diseases. High levels of psychological well‐being, actively engaging in leisure activities, and a rich social network were SPFs. Having ≥1 SPF reduced 47% of AD and 28% of IS risk among people with a low risk profile (<2 SRFs), and 38% of AD and 31% of IS risk with a high risk profile (≥2 SRFs). In total, 57.8% of AD/IS cases could be prevented if individuals have ≥1 SPF and no SRF.

    Discussion: AD and IS share risk/protective profiles, and SPFs seem to counteract the adverse effects of SRFs on both AD and IS.

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  • The relationship between chronic diseases and depression in middle-aged and older adults

    2021. Yu-Han Bi (et al.). Journal of Affective Disorders 289, 160-166


    Background: Evidence of the association between common chronic diseases and depression is sparse.

    Methods: Totally 7819 participants aged 45+ without depression at baseline were followed-up (2011-2015) to detect incident depression. Chronic diseases and depression were defined by self-reported diagnosis and the Center for Epidemiological Studies Depression Scale (CES-D10), respectively. Cox proportional hazards model was used to explore the association between chronic diseases and depression adjusting for age, gender, education, marital/living conditions, area, smoking, drinking, economic status, BMI and health insurance.

    Results: During an average of 3.42 years follow-up, 2271 participants developed depression (85 per 1000 person-year). Chronic diseases were related to significantly higher risk of depression (HR = 1.38). A higher risk of depression was also associated with specific diseases: stomach/other digestive diseases (HR = 1.19), diabetes (HR = 1.22), arthritis/rheumatism (HR = 1.30), and kidney diseases (HR = 1.34) (P < 0.05). The risk of depression increased with increasing in the number of chronic diseases (1: HR = 1.27, 2: HR = 1.49, and 3+: HR = 1.51, P-trend < 0.001). No significant difference was observed across age, gender, education, and area.

    Limitations: Chronic diseases and depression were based on self-reported diagnosis and measurement scale, respectively, which could lead to information bias. Some unmeasured confounders might have biased the results.

    Conclusions: The occurrence of depression in people aged 45+ is associated with number of chronic diseases in a dose-response fashion. These results may provide guidance on preventing depression and improving the quality of life in middle and late adulthood.

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  • Working life job strain status and cognitive aging in Europe

    2021. Lai-Bao Zhuo (et al.). Journal of Affective Disorders 295, 1177-1183


    Background: To examine the association of job strain with cognitive ability and the influence of life-course job strain on later life cognitive decline.

    Methods: Data were derived from six waves of the Survey of Health, Aging, and Retirement in Europe. The study sample consists of 13349 participants aged 50 to 98 years at wave 2 and has been followed up for 12-years. Job strain status across working life was assessed using a short demand-control job strain model containing two core dimensions: job demands and job control collected in wave 3. Cognitive abilities concerning episodic memory was assessed by immediate recall and delayed recall tests, executive function was evaluated by verbal fluency test collected in all waves (waves 2–7) except wave 3. Mixed-effects model was used to estimate working life job strain and its cumulative effect on cognitive decline.

    Results: Both passive and high strain jobs were associated with lower levels of cognitive ability (episodic memory and verbal fluency) in comparison with active job. Long exposure to active- or low strain-job was associated with higher cognitive ability whereas long exposure to passive job or moderate duration of high strain job was associated with lower cognitive ability. The rate of memory decline was positively related to moderate duration of passive job and negatively related to long-term exposure to low strain job.

    Limitations: Information on working conditions was based on self-reported recollections.

    Conclusions: Working life variation in job strain status and their duration may explain individual differences in cognitive ability in later life.

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  • Association of diabetes with stroke and post-stroke dementia

    2020. Ying Shang (et al.). Alzheimer's & Dementia 16 (7), 1003-1012


    Introduction: The impact of prediabetes and diabetes on stroke and the development of dementia after a stroke remain unclear.

    Methods: A total of 2655 dementia-free participants (including a stroke-free cohort and a prevalent stroke cohort) were followed-up for 12 years. Dementia and post-stroke dementia were determined by clinical examinations and national registry data. Diabetes was ascertained via medical examination, medication use, medical records, or glycated hemoglobin (HbA1c) >= 6.5%. Prediabetes was defined as H bA1c >= 5.7% in diabetes-free participants.

    Results: In the stroke-free cohort, 236 participants developed ischemic stroke, and 47 developed post-stroke dementia. Diabetes was associated with ischemic stroke (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.16 to 2.67) and post-stroke dementia (HR 2.56, 95% CI 1.04 to 6.25). In the prevalent stroke cohort, diabetes was also related to dementia risk. Prediabetes was not significantly related to stroke or post-stroke dementia.

    Discussion: Diabetes, but not prediabetes, is associated with an increased risk of ischemic stroke and post-stroke dementia.

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  • Impact of effort reward imbalance at work on suicidal ideation in ten European countries

    2020. Lai-Bao Zhuo (et al.). Journal of Affective Disorders 260, 214-221


    Background: Evidence of the association between effort reward imbalance (ERI) and suicidal ideation is sparse. This study examined the influence of ERI at work on suicidal ideation and the mediating effect of depressive symptoms. Methods: There were 4963 workers aged 50 + without suicidal ideation at baseline in the Survey of Health, Aging and Retirement in Europe, these workers were followed-up for 8-years to detect incident suicidal ideation. ERI was measured by a short ERI questionnaire. Suicidal ideation was evaluated by one item derived from the 12-item Europe-depression scale, and depressive symptoms were assessed by the remaining 11 items in the scale. Cox models were employed to explore the relationship adjusting for potential confounders. Mediation analysis was used to test the mediating effect of depressive symptoms. Results: A significantly higher incidence of suicidal ideation was related with high effort (HR = 1.51) and low reward (HR = 1.42), respectively. A high effort-low reward imbalance was associated with even higher risk of suicidal ideation (HR = 1.96) as compared to low effort-high reward combination. The association was varied by gender, region, education and household income. Depressive symptoms mediated a modest proportion (natural indirect effect 14.4%) of the total association between ERI and suicidal ideation. Limitation: Suicidal ideation definition based on self-administered questionnaires which could lead to false negatives. And some unmeasured confounders might have biased the results. Conclusions: Efforts in promoting balanced effort-reward at work may reduce suicidal ideation among working population aged 50+. Avoiding depressive symptoms may further enhance such efforts.

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  • Late-life depression and the risk of dementia in 14 countries

    2020. Jia-Jia Wu (et al.). Journal of Affective Disorders 274, 671-677


    Background: Depression is the most common mental health problem and often co-occurs with dementia in old age. This study investigates the in fluence of late-life depression on risk of dementia.

    Methods: A total of 16210 dementia-free participants aged 60+ from the Survey of Health, Aging, and Retirement in Europe were followed up for 10 years to detect incident dementia. Depression was assessed by a 12-item Europe-depression scale, dementia was determined by physician diagnosis reported by the participants and their informants. Fine and Gray model was performed to explore the association between depression and incident dementia taking into account competing risk of death.

    Results: During an average of 8 years follow-up, 1030 (6.35%) incident dementia were identi fied. Late-life depression was related to higher subdistribution hazard ratio (sHR) of dementia (sHR=1.52, 95%CI: 1.32-1.75) after adjusting for age, gender, country, education, smoking, drinking, living arrangement, BMI, chronic disease, and physical activity. Further, the risk was only existed in those below age of 80 (sHR=1.75, 95%CI: 1.47-2.07). In addition, a dose-response association was observed between the severity of depression and dementia risk (p for trend<0.001).

    Limitation: The ascertainment of depression and dementia was based on information reported by the participants and/or their informants, which might result in information bias. The causal relationship could not be determined because limited follow-up time.

    Conclusions: Late-life depression is associated with higher incidence of dementia in a dose-response fashion. Interventions targeting depression patients aged 60-79 years and those with severe depression may be e ffective strategies to prevent dementia.

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  • Low Mood and Risk of Dementia

    2020. Linnea Sjöberg (et al.). The American journal of geriatric psychiatry 28 (1), 33-44


    Objective: This study aims to explore whether low mood is related to an increased dementia risk in two cohorts of older adults of different generations, and whether marital status and living situation modify this association. Methods: Participants (>= 70 years), free from dementia and living at home, were identified from two population-based studies: the Kungsholmen Project (KP; n = 1,197) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; n = 1,402). Low mood was obtained by self-report (KP and SNAC-K) at baseline in 1987-89 (KP) and 2001-04 (SNAC-K). Incident dementia cases were ascertained over 9 years, using the same diagnostic procedures and comparable criteria for the two cohorts (DSM-III-R in KP and DSM-IV-TR in SNAC-K). Hazard ratios (HR) were derived from Cox proportional hazards models. Results: Those having low mood at baseline were at higher risk of dementia in both cohorts combined (HR: 1.2, 95% confidence interval (CI): 1.0-1.4) than those without low mood. However, an increased risk was detected only in those who did not have a partner (HR: 1.5, 95% CI: 1.2-1.9), or lived alone (HR: 1.5, 95% CI: 1.2-1.9), but not among those who had a partner or lived with someone (HR: 0.8, 95% CI: 0.5-1.2). Conclusion: Marital status and living situation have the potential to buffer the detrimental effects of low mood on dementia onset. Thus, specific attention from health care should target individuals having low mood and who do not have a partner or live alone.

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  • Mid- to late-life migraine diagnoses and risk of dementia

    2020. Sabrina Islamoska (et al.). Journal of Headache and Pain 21 (1)


    Background: Previous studies found an association between migraine and dementia, which are two leading causes of disability. However, these studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Additionally, we explored potential differences in dementia risk for migraine with and without aura.

    Methods: We obtained data on birth cohorts born between 1935 and 1956 (n = 1,657,890) from Danish national registers. Individuals registered with migraine before age 59 (n = 18,135) were matched (1:5) on sex and birthdate with individuals without migraine (n = 1,378,346). Migraine was defined by International Classification of Diseases (ICD) diagnoses and dementia was defined by ICD diagnoses and anti-dementia medication. After matching, 62,578 individuals were eligible for analysis. For the statistical analyses, we used Cox regression models and adjusted for socio-demographic factors and several psychiatric and somatic morbidities.

    Results: During a median follow-up time of 6.9 (IQR: 3.6-11.2) years, 207 individuals with migraine developed dementia. Compared with individuals without migraine, we found a 50% higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28-1.76). Individuals without aura had a 19% higher rate of dementia (HR = 1.19; 95% CI: 0.84-1.70), and individuals with aura had a two times higher rate of dementia (HR = 2.11; 95% CI: 1.48-3.00).

    Conclusions: Our findings support the hypothesis that migraine is a midlife risk factor for dementia in later life. The higher rate of dementia in individuals with a hospital-based diagnosis of migraine with aura emphasizes the need for studies on pathological mechanisms and potential preventative measures. Furthermore, given that only hospital-based migraine diagnoses were included in this study, future research should also investigate migraine cases derived from the primary healthcare system to include less severe migraine cases.

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  • Psychosocial job strain and polypharmacy

    2020. Edwin C. K. Tan (et al.). Scandinavian Journal of Work, Environment and Health 46 (6), 589-598


    Objectives: Psychosocial job strain has been associated with a range of adverse health outcomes. The aim of this study was to examine the association between psychosocial job strain and prospective risk of polypharmacy (the prescription of ≥5 medications) and to evaluate whether coping strategies can modify this risk.

    Methods: Cohort study of 9703 working adults [mean age 47.5 (SD 10.8) years; 54% female] who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH) at baseline in 2006 or 2008. Psychosocial job strain was represented by job demands and control, and measured by the Swedish version of the demand–control questionnaire. The outcome was incidence of polypharmacy over an eight-year follow-up period. Information on dispensed drugs were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to estimate the association of job strain status with polypharmacy, adjusted for a range of confounders.

    Results: During the follow-up, 1409 people developed polypharmacy (incident rate: 20.6/1000 person-years). In comparison to workers with low-strain jobs (high control/low demands), those with high-strain jobs (low control/high demands) had a significantly higher risk of incident polypharmacy (OR 1.40, 95% CI 1.04–1.89). The impact of high-strain jobs on developing polypharmacy remained among those with covert coping strategies (ie, directed inwards or towards others) but not among those with open coping strategies (ie, primarily directed toward the stressor).

    Conclusions: Workers in high-strain jobs may be at an increased risk of polypharmacy. Open coping strategies may reduce the negative impact of psychosocial job strain on risk of polypharmacy.

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