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Differences in hospitalizations between employment industries, Finland 1976 to 2010.

https://arctichealth.org/en/permalink/ahliterature265808
Source
Ann Epidemiol. 2014 Aug;24(8):598-605.e1
Publication Type
Article
Date
Aug-2014
Author
Lauri Kokkinen
Anne Kouvonen
Aki Koskinen
Pekka Varje
Ari Väänänen
Source
Ann Epidemiol. 2014 Aug;24(8):598-605.e1
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Diagnosis-Related Groups - trends
Female
Finland - epidemiology
Health Status Disparities
Hospitalization - trends
Humans
Longitudinal Studies
Male
Mental Disorders - epidemiology
Middle Aged
Morbidity - trends
Occupational Health - trends
Occupations - classification - trends
Patient Discharge - trends
Proportional Hazards Models
Registries
Sex Distribution
Socioeconomic Factors
Young Adult
Abstract
The aim of this study was to investigate the differences in hospitalizations between different industries in the Finnish working-age population between 1976 and 2010.
Participants (n = 3,769,355) were randomly selected from seven independent consecutive national cohorts in the Statistics Finland population database, each representing a 25% sample of the working-age (18-65-year-old) population. These data were linked with diagnosis-specific records on hospitalizations, drawn from the National Hospital Discharge Registry (mean follow-up time per cohort was 4.1 years) using personal identification numbers.
Sociodemographics-adjusted models showed differences between the proportional hazard ratios of employment industries in all-cause hospitalization. These differences remained fairly stable (hazard ratio [HR], 0.95-1.24) throughout the 35-year period. The differences between industries varied the most in hospitalizations for mental disorders. These differences were substantial during 1976 to 1980 (HR, 1.16-2.29), decreased considerably and remained moderate between 1981 and 2000 (HR, 0.92-1.64), and then increased notably between 2001 and 2010 (HR, 1.09-2.34).
The cause-specific hospitalizations of different employment industries have varied, but the differences in all-cause hospitalizations have remained fairly stable, with the ranking among industries remaining almost the same over the past 35 years.
PubMed ID
25084703 View in PubMed
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Distinctive role of income in the all-cause mortality among working age migrants and the settled population in Finland: A follow-up study from 2001 to 2014.

https://arctichealth.org/en/permalink/ahliterature291134
Source
Scand J Public Health. 2018 Mar; 46(2):214-220
Publication Type
Journal Article
Date
Mar-2018
Author
Kishan Patel
Anne Kouvonen
Aki Koskinen
Lauri Kokkinen
Michael Donnelly
Dermot O'Reilly
Ari Vaananen
Author Affiliation
1 Administrative Data Research Centre - Northern Ireland, Centre for Public Health, Queen's University Belfast, UK.
Source
Scand J Public Health. 2018 Mar; 46(2):214-220
Date
Mar-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Cause of Death - trends
Female
Finland - epidemiology
Follow-Up Studies
Health Status Disparities
Humans
Income - statistics & numerical data
Male
Middle Aged
Registries
Risk
Transients and Migrants - statistics & numerical data
Young Adult
Abstract
Although income level may play a significant part in mortality among migrants, previous research has not focused on the relationship between income, migration and mortality risk. The aim of this register study was to compare all-cause mortality by income level between different migrant groups and the majority settled population of Finland.
A random sample was drawn of 1,058,391 working age people (age range 18-64 years; 50.4% men) living in Finland in 2000 and linked to mortality data from 2001 to 2014. The data were obtained from Statistics Finland. Cox proportional hazards models were used to investigate the association between region of origin and all-cause mortality in low- and high-income groups.
The risk for all-cause mortality was significantly lower among migrants than among the settled majority population (hazards ratio (HR) 0.57; 95% confidence interval (CI) 0.53-0.62). After adjustment for age, sex, marital status, employment status and personal income, the risk of mortality was significantly reduced for low-income migrants compared with the settled majority population with a low income level (HR 0.46; 95% CI 0.42-0.50) and for high-income migrants compared with the high-income settled majority (HR 0.81; 95% CI 0.69-0.95). Results comparing individual high-income migrant groups and the settled population were not significant. Low-income migrants from Africa, the Middle East and Asia had the lowest mortality risk of any migrant group studied (HR 0.32; 95% CI 0.27-0.39).
Particularly low-income migrants seem to display a survival advantage compared with the corresponding income group in the settled majority population. Downward social mobility, differences in health-related lifestyles and the healthy migrant effect may explain this phenomenon.
PubMed ID
28905684 View in PubMed
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"First, Do No Harm": Have the Health Impacts of Government Bills on Tax Legislation Been Assessed in Finland?

https://arctichealth.org/en/permalink/ahliterature296174
Source
Int J Health Policy Manag. 2018 04 25; 7(8):696-698
Publication Type
Journal Article
Date
04-25-2018
Author
Natassa Aaltonen
Miisa Chydenius
Lauri Kokkinen
Author Affiliation
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
Source
Int J Health Policy Manag. 2018 04 25; 7(8):696-698
Date
04-25-2018
Language
English
Publication Type
Journal Article
Keywords
Alcohol Drinking - economics - legislation & jurisprudence
Commerce - legislation & jurisprudence
Finland
Food Industry - economics - legislation & jurisprudence
Government
Government Regulation
Health equity
Health Impact Assessment
Health Policy
Health Promotion - methods
Humans
Population health
Taxes
Tobacco Products - economics - legislation & jurisprudence
Abstract
As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007-2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated.
Notes
Cites: Lancet. 2008 Nov 8;372(9650):1661-9 PMID 18994664
Cites: J Epidemiol Community Health. 2017 Aug;71(8):745-746 PMID 28416570
Cites: Health Promot Int. 2017 Nov 14;:null PMID 29149295
Cites: Health Res Policy Syst. 2018 Mar 15;16(1):26 PMID 29544496
PubMed ID
30078289 View in PubMed
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Human service work, gender and antidepressant use: a nationwide register-based 19-year follow-up of 752 683 women and men.

https://arctichealth.org/en/permalink/ahliterature302198
Source
Occup Environ Med. 2018 06; 75(6):401-406
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-2018
Author
André Buscariolli
Anne Kouvonen
Lauri Kokkinen
Jaana I Halonen
Aki Koskinen
Ari Väänänen
Author Affiliation
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Source
Occup Environ Med. 2018 06; 75(6):401-406
Date
06-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Antidepressive Agents - therapeutic use
Depressive Disorder - drug therapy - epidemiology
Female
Finland - epidemiology
Follow-Up Studies
Health Personnel - psychology
Humans
Male
Middle Aged
Proportional Hazards Models
Risk factors
Sex Factors
Abstract
To examine antidepressant use among male and female human service professionals.
A random sample of individuals between 25 years and 54 years of age (n=752?683; 49.2% women; mean age 39.5 years). Information about each individual's filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs.
The hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95%?CI 1.18 to 1.27), but this was not the case for women (0.99, 95%?CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk.
Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk.
Notes
CommentIn: Occup Environ Med. 2018 Jun;75(6):399-400 PMID 29680806
PubMed ID
29374096 View in PubMed
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Implementation of Health 2015 public health program in Finland: a welfare state in transition.

https://arctichealth.org/en/permalink/ahliterature301967
Source
Health Promot Int. 2019 Apr 01; 34(2):258-268
Publication Type
Journal Article
Date
Apr-01-2019
Author
Lauri Kokkinen
Carles Muntaner
Patricia O'Campo
Alix Freiler
Golda Oneka
Ketan Shankardass
Author Affiliation
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
Source
Health Promot Int. 2019 Apr 01; 34(2):258-268
Date
Apr-01-2019
Language
English
Publication Type
Journal Article
Keywords
Cooperative Behavior
Finland
Global health
Health Policy
Health Promotion - economics
Humans
Interviews as Topic
Organizational Case Studies
Politics
Program Evaluation
Public Health - economics
Abstract
Our study sought to examine the implementation of Health 2015 [a public health programme prepared following the principles of Health in All Policies (HiAP)] between 2001 and 2015 in the context of welfare state restructuring. We used data from the realist multiple explanatory case study by HARMONICS, which focused on political factors (processes) that lead to the (un)successful implementation of programmes following the principles of HiAP. We analyzed data-key informant interviews, grey and scholarly literature-from our Finnish case to examine how Health 2015 implementation has been affected by the changing role of the state. We find that the dismantling of formal funding allocation decreased the capacity of national authorities to exert control over municipalities' health promotion work, diluting the financial arrangements regarding municipal obligations. As a result, most municipalities failed to contribute to Health 2015, resulting in losses for health promotion activities. Our results also point to joining the EU. Whereas the procedures for preparing Finland's unanimous positions on EU matters were useful in harmonizing ideologies on various policy issues between different ministries, joining the EU also increased commercial interests and the strength of the lobby system, leading to the prioritization of economic objectives over public health objectives. Finally, our informants also highlighted the changing relationship between the state and the market, manifested in market deregulation and increasing influence of pro-growth arguments during the implementation of Health 2015.
PubMed ID
29149295 View in PubMed
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The implementation of Health in All Policies initiatives: a systems framework for government action.

https://arctichealth.org/en/permalink/ahliterature295162
Source
Health Res Policy Syst. 2018 Mar 15; 16(1):26
Publication Type
Journal Article
Date
Mar-15-2018
Author
Ketan Shankardass
Carles Muntaner
Lauri Kokkinen
Faraz Vahid Shahidi
Alix Freiler
Goldameir Oneka
Ahmed M Bayoumi
Patricia O'Campo
Author Affiliation
Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. kshankardass@wlu.ca.
Source
Health Res Policy Syst. 2018 Mar 15; 16(1):26
Date
Mar-15-2018
Language
English
Publication Type
Journal Article
Keywords
Administrative Personnel
Finland
Global health
Government
Health equity
Health Policy
Health promotion
Humans
Policy Making
Social Determinants of Health
Systems Theory
Abstract
There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP.
Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process.
We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward.
This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.
Notes
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PubMed ID
29544496 View in PubMed
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National trends in main causes of hospitalization: a multi-cohort register study of the finnish working-age population, 1976-2010.

https://arctichealth.org/en/permalink/ahliterature268463
Source
PLoS One. 2014;9(11):e112314
Publication Type
Article
Date
2014
Author
Anne Kouvonen
Aki Koskinen
Pekka Varje
Lauri Kokkinen
Roberto De Vogli
Ari Väänänen
Source
PLoS One. 2014;9(11):e112314
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cardiovascular Diseases - epidemiology
Cohort Studies
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Musculoskeletal Diseases - epidemiology
Neoplasms - epidemiology
Registries
Respiration Disorders - epidemiology
Risk
Young Adult
Abstract
The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change.
National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years.
Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed.
A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.
Notes
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PubMed ID
25379723 View in PubMed
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Occupational class and the changing patterns of hospitalization for affective and neurotic disorders: a nationwide register-based study of the Finnish working-age population, 1976-2010.

https://arctichealth.org/en/permalink/ahliterature296108
Source
Soc Psychiatry Psychiatr Epidemiol. 2018 02; 53(2):131-138
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2018
Author
Pekka Varje
Anne Kouvonen
Lauri Kokkinen
Aki Koskinen
Ari Väänänen
Author Affiliation
Work Disability Prevention Centre, Finnish Institute of Occupational Health, PO Box 40, 00032, Helsinki, Finland. pekka.varje@ttl.fi.
Source
Soc Psychiatry Psychiatr Epidemiol. 2018 02; 53(2):131-138
Date
02-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Mood Disorders - epidemiology - psychology
Neurotic Disorders - epidemiology - psychology
Occupational Diseases - epidemiology - psychology
Occupations - statistics & numerical data
Proportional Hazards Models
Registries
Young Adult
Abstract
This study aimed to examine the long-term changes and socioeconomic disparities in hospitalization for affective and neurotic disorders among the Finnish working-age population from 1976 to 2010.
Register-based study, consisting of a 5-year follow-up of 3,223,624 Finnish working-age (18-64-year old) individuals in seven consecutive cohorts. We calculated the hazard ratios of psychiatric hospitalization for different occupational classes using Cox regression models.
The risk of hospitalization for affective and neurotic disorders increased in all occupational classes after the economic recession in the 1990s, and then decreased in the 2000s. Before the 2000s, the risk was the highest among manual workers. In the 2000s the disparities between upper-level non-manual employees and other occupational classes increased. Hospitalization rates remained high among female manual workers and non-manual lower-level employees.
This study revealed important similarities and differences between occupational classes in terms of long-term changes in hospitalization for affective and neurotic disorders. The results suggest that the labor market changes and healthcare reforms during the 1990s and 2000s in Finland have been more beneficial for higher than for lower occupational classes.
Notes
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PubMed ID
29236136 View in PubMed
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Occupational class, capitalist class advantage and mortality among working-age men.

https://arctichealth.org/en/permalink/ahliterature308627
Source
J Epidemiol Community Health. 2020 01; 74(1):3-6
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2020
Author
Lauri Kokkinen
Carles Muntaner
Aki Koskinen
Ari Väänänen
Author Affiliation
Faculty of Social Sciences, Tampere University, Tampere, Finland lauri.kokkinen@tuni.fi.
Source
J Epidemiol Community Health. 2020 01; 74(1):3-6
Date
01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Employment - statistics & numerical data
Finland - epidemiology
Humans
Male
Middle Aged
Mortality
Occupations - statistics & numerical data
Salaries and Fringe Benefits
Social Class
Socioeconomic Factors
Abstract
Disparities in mortality have been firmly established across occupational grades and the incomes they earn, but this line of research has failed to include individuals' relationships to capital, as suggested by class analysists.
According to Wright's classification, the research generated 10 mutually exclusive classes based on occupation and investment income: worker; capitalist worker; professional; capitalist professional; supervisor; capitalist supervisor; manager; capitalist manager; self-employed; and capitalist self-employed. The study participants (n=268?239) were randomly selected from the Statistics Finland population database and represent 33% of Finnish men aged 30-64 years. The mortality data were monitored over the 1995-2014 period.
The sociodemographic-adjusted HRs for mortality were lowest for capitalist managers (HR 0.50; 95%?CI 0.36 to 0.69) as compared with that for workers without a capitalist class advantage. A positive occupational class gradient was found from managers to supervisors to workers. The capitalist class advantage independently affected the disparities in mortality within this occupational hierarchy.
Different occupational class locations protect against premature death differently, and the capitalist class advantage widens the premature-death disparities among the occupational classes. To monitor and explain social inequalities in health in a more nuanced way, future research on investment income as well as the operationalisation of the capitalist class advantage is encouraged.
Notes
CommentIn: J Epidemiol Community Health. 2020 Jan;74(1):1-2 PMID 31615891
PubMed ID
31615892 View in PubMed
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Occupational groups and main causes of hospitalization: a longitudinal multicohort study of the Finnish working-age population, 1976 to 2010.

https://arctichealth.org/en/permalink/ahliterature262733
Source
J Occup Environ Med. 2014 Aug;56(8):886-91
Publication Type
Article
Date
Aug-2014
Author
Pekka Varje
Lauri Kokkinen
Anne Kouvonen
Aki Koskinen
Ari Väänänen
Source
J Occup Environ Med. 2014 Aug;56(8):886-91
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - epidemiology
Finland - epidemiology
Health Transition
Hospitalization - statistics & numerical data
Humans
Longitudinal Studies
Mental Disorders - epidemiology
Musculoskeletal Diseases - epidemiology
Occupations - classification
Registries
Respiratory Tract Diseases - epidemiology
Abstract
To determine whether transitions in the hospitalization structure of different occupational groups have followed similar trends.
Secular trends for all-cause hospitalization and five main diagnostic categories among six occupational groups were examined between 1976 and 2010 in Finland. The register-based study consisted of a 5-year follow-up of 1,126,499 Finnish working-aged residents in seven consecutive cohorts.
Altogether 451,737 hospitalizations were investigated in 1976 to 2010. The risks of all-cause hospitalization, mental disorders, and respiratory illnesses remained relatively stable, whereas that of musculoskeletal disorders increased (between 31% and 90%) and that of cardiovascular diseases decreased (between 41% and 62%) in all occupational groups. The highest variation was found for cancer.
A common health transition pattern seems to have occurred in the occupational groups studied. Nevertheless, the health disparities between the groups were sustained.
PubMed ID
25099417 View in PubMed
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13 records – page 1 of 2.