This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989-1996) and recovery (1997-2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989-1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997-2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.
To estimate changes in the total and independent effects of education and occupational social class on mortality over 30 years, and to assess the causes of changes in the independent effects.
Census records linked with death records for 1971-2000 for all Finns aged 30-59 years were studied. The total and independent effects of education and social class on mortality were calculated from relative risks in nested Poisson regression models.
Among men and women, the model shows that the total effects of education, and particularly occupational social class on mortality, have increased over time. Among 40-59-year-old people, the effects of education are currently less independent of social class than in the 1970s, but among younger Finns the independent effects have remained stable. The effects of social class on mortality that are independent of education have grown among people of older ages, particularly among men.
Changes in the independent effects of socioeconomic measures on mortality are determined by changes in their associations with mortality, and distributional changes that affect the strength of the associations between these measures. Distributional changes are driven by changes in educational systems and labour markets, and are of major importance for the understanding of socioeconomic inequalities in mortality.
Cites: Ann Epidemiol. 2001 Feb;11(2):75-8411164123
Lower mortality has been systematically found in married when compared with non-married, especially in men, but little is known about marital status differences in mortality from external causes. Furthermore, the role of cohabitation and partnership history in the formation of these differences and how they have been changed over time are poorly understood.
The incidence of fatal and non-fatal cases of accidents, violence and suicides by partnership history was analysed during 1991-1997 and 2001-2007 in a representative sample of the Finnish population aged 26-59 years. HRs were calculated using Cox proportional hazards models.
Incidence rates in accidents, violence and suicides were generally lower in men and women living with a partner than those living alone. Current cohabitation and previous divorce increased the risk of all of these outcomes when compared with married without previous divorce. Higher incidence rates were found in men who had divorced 3 years ago or earlier when compared with those who had divorced later. Generally, these differences were larger in fatal than in non-fatal cases and significantly larger in men. There was little change in these differences between 1991-1997 and 2001-2007. These differences were partly explained by socioeconomic factors but remained statistically significant also after these adjustments.
Currently living without a partner and cohabitation and previous divorce increased the risk of accidents, violence and suicides. This indicates that also other mechanisms than immediate support from a partner are important in the formation of marital status differences in mortality.
We estimated the contribution of smoking to educational differences in mortality and life expectancy between 1971 and 2010 in Finland.
Eight prospective datasets with baseline in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005 and each linked to a 5-year mortality follow-up were used. We calculated life expectancy at age 50 years with and without smoking-attributable mortality by education and gender. Estimates of smoking-attributable mortality were based on an indirect method that used lung cancer mortality as a proxy for the impact of smoking on mortality from all other causes.
Smoking-attributable deaths constituted about 27% of all male deaths above age 50 years in the early 1970s and 17% in the period 2006-2010; these figures were 1% and 4% among women, respectively. The life expectancy differential between men with basic versus high education increased from 3.4 to 4.7 years between 1971-1975 and 2006-2010. In the absence of smoking, these differences would have been 1.5 and 3.4 years, 1.9 years (55%) and 1.3 years (29%) less than those observed. Among women, educational differentials in life expectancy between the most and least educated increased from 2.5 to 3.0 years. This widening was nearly entirely accounted for by the increasing impact of smoking. Among women the contribution of smoking to educational differences had increased from being negligible in 1971-1975 to 16% in 2006-2010.
Among men, the increase in educational differences in mortality in the past decades was driven by factors other than smoking. However, smoking continues to have a major influence on educational differences in mortality among men and its contribution is increasing among women.
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Socioeconomic mortality differences have increased in many high-income countries in recent decades mainly because of slower mortality decline among the lower social groups. The aim of this study was to investigate whether the changing socio-demographic composition explains the increasing disparity in mortality by income and the stagnation of mortality in the lowest income group.
The register data comprised a nationally representative 11% sample of individuals aged 35-64 years residing in Finland in 1988-2007, linked with mortality records. Household taxable income was used as the income measure. Poisson regression models were used to assess the changes in mortality disparity among the income quintiles between periods 1988-1991, 1996-1999 and 2004-2007. The measures of socio-demographic composition included educational level, social class, employment status and living alone.
The mortality rate ratio (with the highest quintile as the reference category) of the lowest quintile increased from 2.80 to 5.16 among the men and from 2.17 to 4.23 among the women between 1988-1991 and 2004-2007. Controlling for other socio-demographic variables strongly attenuated the differences, but the rate ratio of the lowest quintile still increased from 1.32 to 1.73 among the men and from 1.13 to 1.66 among the women. There was no decline in the fully adjusted mortality of the lowest quintiles between second and third study periods.
Socio-demographic characteristics explained much of the mortality disparity between income quintiles within each study period. However, these characteristics do not explain the increasing disparity between the periods and stagnating mortality in the lowest quintile.
Being currently not married is more common today than 25 years ago. Over this period relative differences in mortality by marital status have increased in several countries, mainly as a result of a sharp decline in mortality among the married. Using Finnish census data linked with death certificates, we show that these increases are not explained by the non-married population becoming more marginalized in socio-economic status or household composition. However, the increases in marital-status differences in mortality from accidental, violent, and alcohol-related causes of death in the 30-64 age group indicate that changes in the health-related behaviour of the non-married population may play a role. The public-health burden associated with not being married has also grown. At the end of the 1990s about 15 per cent of all deaths above the age of 30 would not have occurred if the non-married population had had the same age-specific mortality rates as the married population.
A growing number of children live in single-parent families, which seems to be associated with negative effects on a child's health. Little is known about the health of children in cohabiting two-parent families that are also increasingly common, and more susceptible to family break-up than married two-parent families. This study seeks to determine if family type is associated with child mortality and whether any association remains after controlling for socio-economic factors.
We used longitudinal nationally representative register data from Statistics Finland to study deaths between ages 1-14 years (1780 deaths, N = 201,211) during 1990-2004. The relative effects of family characteristics on mortality were estimated using Cox regression models.
Compared with children of married parents, children of single parents carried an excess risk in mortality in ages 1-4 years [Hazard Ratio (HR) 2.02, 95% CI 1.63-2.51] and in ages 5-9 years (HR 1.44, 95% CI 1.15-1.80). The relationship between single parenthood and mortality was largely, but not entirely, explained by associated low parental education and lower household income. Mortality among children in cohabiting-parent families showed no difference from children of married parents.
Mainly due to accidental and violent causes of death, the largest excess mortality risks concentrated among children of single, less-educated and less-earning parents. The most vulnerable age period in this respect was early childhood (ages 1-4 years), whereas no association between mortality and family type was found among children aged 10-14 years.
To improve our understanding of the association between income and mortality, we analysed prospective record linkage data on Finns aged 30 and over in 1997. The results show a weaker association of mortality with household disposable income-the measure that best captures consumption potential-than with individual income, particularly above age 65 when the ability to work does not bias the associations. The association between income and mortality is greatly weakened by adjustment for socio-economic status and economic activity, and there is also weak evidence of curvature in the relationship with household disposable income. Among younger participants, social characteristics of the family of origin and early career incomes have a very limited effect on the association between adult income and mortality. The causal effects of income on mortality remain difficult to establish with certainty, and may easily be overestimated. Causal explanations based solely on material factors should be treated with scepticism.
We studied whether migration influences the relationship between area socioeconomic structure and mortality. We used data on Finns aged 25-64 that are linked to information on proportions of manual workers in 85 functional regions in 1987 and 1997, and on deaths in 1998-2004. Participants aged 25-44 moving to areas with a lower proportion of manual workers had lower mortality and those moving to areas with a higher proportion of manual workers had mortality similar to those residing in these areas at both time points. Among the 45-64-year-olds, all migrants between areas had increased mortality. However, because these mortality differences and the migratory flows were relatively small, their effects on area socioeconomic differences in mortality were also small.
. Objectives were to study the effects of socioeconomic factors on transitions in living arrangements and mortality for men and women.
We used a sample of Finns aged 65 years and older living alone or with a partner at the end of 1997 (N = 250,787) drawn from population registers, and followed them up for transitions in living arrangements (with partner, alone, with others, institutionalized) and death at the end of 2002.
Health conditions associated with functional difficulties were major determinants of institutionalization and death and were associated with transitions between private households. Low income among men and in particular not owning a home were independently associated with institutionalization and death among those living alone or with a partner at baseline. Among those living with a partner, the transition to living alone was associated with all socioeconomic factors but most strongly with a low income and not owning a home. Transitions to living with others were associated in particular with low occupational social class and education.
Variations in the associations of different socioeconomic indicators with living arrangement transitions imply different social pathways. However, material socioeconomic indicators dominated other measures of socioeconomic status in determining such transitions, and their effects were only partly mediated by chronic conditions.