Economic Recession and the Risk of Cancer : A Cohort Study From Eastern Finland

Background: Little is known about the role of economic recessions in the risk of cancer. Therefore, we evaluated the impact of the severe economic recession in Finland from 1991–1994 on the incidence of all cancers and cancer subtypes among a middle-age and older population. Methods: From the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), a population-based sample of 1,620 women and men aged 53–73 years were examined from 1998–2001. The cancer-free participants completed a questionnaire on the possible impact of the 1990s recession in Finland on their lives. Incident cases of cancer were obtained through record linkage with the Finnish Cancer Registry. Cox proportional hazards regression was used to estimate hazard ratios (HR) of incident cancer events after adjusting for possible confounders. Results: A total of 1,096 cancer-free participants had experienced socioeconomic hardships due to the recession at the baseline. During 20 years of follow-up, 473 participants developed cancer. After adjustment for age, baseline socioeconomic position, and lifestyle factors, the risk of all cancers was 32% higher among men who experienced socioeconomic hardships compared to those who did not (HR 1.32; 95% confidence interval [CI], 1.00–1.74, P = 0.05). Prostate-genital cancer was 71% higher among men with hardships (n = 103, HR 1.71; 95% CI, 1.06–2.74, P = 0.02). No association was observed between socioeconomic hardships and subsequent risk of total or any subtype of cancer among women. Conclusion: The 1990s economic recession was associated with increased risk of all cancers, especially prostate-genital cancer among Finnish middle-age and older men, but no association with cancer was observed in women

Economic recession and cardiovascular disease among women : a cohort study from Eastern Finland

AIMS: Little is known about the effect of economic recessions on cardiovascular disease. Therefore, we investigated the association of the economic recession in Finland in the 1990s with the incidence of cardiovascular disease among middle-aged and older women. METHODS: A total of 918 women aged 53-73 years were examined for health and socioeconomic position in 1998-2001, as part of the population-based prospective Kuopio Ischaemic Heart Disease Risk Factor Study. The participants were asked whether Finland's economic recession in the early 1990s had affected their lives socially or economically. The cohort was followed for 18 years, and incident physician-diagnosed cases of cardiovascular disease were obtained through record linkage with the national hospital discharge registry that covers every hospitalisation in Finland. Cox proportional hazards regression models were used to estimate the risk of cardiovascular disease among those with and without exposure to socioeconomic hardships during the recession, after adjusting for possible confounders. RESULTS: At the baseline, 587 women reported having experienced socioeconomic hardships due to the recession. During the 20 years' follow-up, 501 women developed cardiovascular disease. After adjustment for age, the risk of cardiovascular disease was 27% higher among women exposed to socioeconomic hardships compared to those who were not (hazard ratio 1.27, 95% confidence interval 1.06-1.53, P=0.012). Further adjustments for overall socioeconomic position at baseline, prior cardiovascular health, and lifestyle factors did not attenuate the association (hazard ratio 1.23, 95% confidence interval 1.02-1.5, P=0.029). CONCLUSIONS: The early 1990s economic recession was associated with a subsequently increased risk of cardiovascular disease among Finnish women

Association of personal wealth indicators and health care costs in persons with Alzheimer's disease

Objectives There is paucity of studies on the relationship between personal wealth and health care costs among persons with dementia, and earlier studies on other indicators of socioeconomic position have assessed costs after dementia diagnosis only. We investigated how different indicators of personal wealth (disposable income, supplementary income, assets subject to taxation, taxes and tax-like payments, and liabilities) are associated with health care costs in persons with Alzheimer's disease (AD) before and after AD diagnosis. Design Register-based nationwide cohort study of persons with AD. Setting and Participants Cohort of 70,531 people who received a clinically verified AD diagnosis in Finland between 2005 and 2011 and were community-dwelling at time of diagnosis. Methods Data on income indicators were obtained from Statistics Finland. Data on medication costs and hospital care costs for the 12-month period from 5 years before to 2 years after AD diagnosis were obtained from national registers. Associations of wealth indicators with costs were investigated with multivariate mixed-effect negative binomial regression. Results After adjustment for age, region, sex, marital status, comorbidities, expensive medications, use of psychotropic and antidementia medication, and highest occupational class before AD, people with higher levels of personal wealth indicators were more likely to have higher total health care costs along the whole follow-up period. The incidence rate ratios (IRRs), 95% CI for highest quintile vs lowest quintile were 1.17, 1.15−1.19 for disposable income, 1.10, 1.08−1.12 for taxable income, 1.18, 1.16−1.19 for supplementary income, 1.07, 1.06−1.09 for taxes, and 1.05, 1.04−1.07 for taxable wealth. Conclusions and Implications Our observation on the association between income/wealth indicators and health care costs in a country with a strong public health care system call for more effective measures in targeting health inequalities in the aging population. Although the different indicators were not completely interchangeable, associations of different indicators were toward the same direction

Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland

A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession