Does the socioeconomic context explain both mortality and income inequality? Prospective register-based study of Norwegian regions

Abstract Background Studies from various countries have observed worse population health in geographical areas with more income inequality. The psychosocial interpretation of this association is that large income disparities are harmful to health because they generate relative deprivation and undermine social cohesion. An alternative explanation contends that the association between income inequality and ill health arises because the underlying social and economic structures will influence both the level of illness and disease and the size of income differences. This paper examines whether the observed association between mortality and income inequality in Norwegian regions can be accounted for by the socioeconomic characteristics of the regions. Methods Norwegian register data covering the entire population were utilised. An extensive set of contextual and individual predictors were included in multilevel Poisson regression analyses of mortality 1994-2003 among 1.6 millions individuals born 1929-63, distributed across 35 residential regions. Results Mean income, composition of economic branches, and percentage highly educated in the regions were clearly connected to the level of income inequality. These social and economic characteristics of the regions were also markedly related to regional mortality levels, after adjustment for population composition, i.e., the individual-level variables. Moreover, regional mortality was significantly higher in regions with larger income disparities. The regions' social and economic structure did not, however, account for the association between regional income inequality and mortality. A distinct independent effect of income inequality on mortality remained after adjustment for regional-level social and economic characteristics. Conclusions The results indicate that the broader socioeconomic context in Norwegian regions has a substantial impact both on mortality and on the level of income disparities. However, the results also suggest, in a way compatible with the psychosocial interpretation, that on top of the general socioeconomic influences, a higher level of income inequality adds independently to higher mortality levels. Previous publication This article is a reworked version of the study 'Er inntektsforskjeller dødelige?' [Are income inequalities lethal?] which was published in Norwegian in Tidsskrift for velferdsforskning [Journal for welfare research], Vol. 13 (4), 2010.</p

Forskningskommentar: Hvor har den nye genforskningen brakt oss?

Er skoletapere genetisk forskjellige fra skolelys?1 Satt på spissen var det spørsmålet for en australsk studie om gener og utdanning (Martin et al. 2011). Forskerne undersøkte ikke mindre enn 2,5 millioner genetiske forskjeller (dvs. SNPer, se nedenfor). Jakten ga få resultater. Bare én av genvariantene hadde en statistisk signifikant, men svært svak sammenheng med utdanningsnivået til de 9500 individene i utvalget. Samlet gjorde den genetiske variasjonen rede for kun 0,2 prosent – to promille – av ulikhetene i utdanning

‘Crowded out’? Immigration Surge and Residents’ Employment Outcomes in Norway

This study uses Norwegian public register data in a spatial correlation approach, and analyzes associations between regional variations in immigration and employment outcomes 2004–2015 in a cohort of adult residents (N = 1.3 million). A higher share of immigrants in the regional population and an immigrant population dominated by low-educated were associated with slightly negative work income trends and less employment opportunities for residents, in particular for low- educated natives and earlier immigrants. A steep increase in the immigrant share of the regional population was, on the other hand, associated with better employment outcomes for all analyzed resident categories. Overall, regional immigration differences were only modestly related to the out- comes. Findings indicate that the institutional context has limited the role of market mechanisms in the labor market, and a booming regional economy will tend to neutralize potentially negative effects of immigration on residents’ employment

Fordelingsvirkninger av overføringer og trygdekutt blant alvorlig syke menn

Artikkelen analyserer inntektsutviklingen 1993–2008 blant menn som døde av sykdom i 2009/2010 mens de var i 60-årsalderen (N=4611). Et typisk forløp er at inntektene fra eget arbeid begynner å falle om lag ti år før dødsfallet og går etter hvert mot null. Bortfallet av arbeidsinntekter starter gjerne 5–6 år tidligere blant lavt utdannede enn blant høyt utdannede. Selv om en fatal sykdom begrenser deltakelsen i lønnet arbeid, vil nivået på samlet personinntekt ofte holde seg ganske stabilt ettersom velferdsstatens overføringer i stor grad kompenserer for nedgangen i arbeidsinntekt. De sosioøkonomiske forskjellene i muligheten for arbeidsinntekter når en blir alvorlig syk innebærer at reduserte ytelser for syke og uføre i særlig grad vil ramme lavt utdannede og føre til større sosial ulikhet i inntekt

Is it Easier to Be Unemployed When the Experience Is More Widely Shared? Effects of Unemployment on Self-rated Health in 25 European Countries with Diverging Macroeconomic Conditions

The economic crisis in Europe since 2008 has led to high unemployment levels in several countries. Previous research suggests that becoming unemployed is a health risk, but is job loss and unemployment easier to cope with when unemployment is widespread? Using EU-SILC panel data (2010-2013), this study examines short-term effects of unemployment on self-rated health (SRH) in 25 European countries with diverging macroeconomic conditions. Ordinary least squares regressions show that the unemployed are in worse health than the employed throughout Europe. The association is reduced considerably, but remains significant in several countries when time-invariant personal characteristics are accounted for using individual-level fixed-effects models. Propensity score kernel matching shows that both being and becoming unemployed are associated with slightly worse SRH. There is a weak tendency towards less health effects of unemployment in countries where the experience is widely shared. In particular, countries with a very low unemployment rate stand out with larger health effects. The results overall suggest that a changed composition of the unemployed population is an important explanation for the weaker unemployment - health association in high-unemployment countries

Immigrants’ utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway

Purpose As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Methods Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0–59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008–2011 according to country of origin, age group, reason for immigration, and length of stay. Results Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Conclusion Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant populationpublishedVersio

Contribution of smoking and alcohol consumption to income differences in life expectancy : evidence using Danish, Finnish, Norwegian and Swedish register data

Background Despite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few studies have focused on variations in alcohol-related and smoking-related mortality within the Nordic countries. We assess the contribution of smoking and alcohol to differences in life expectancy between countries and between income quintiles within countries. Methods We collected data from registers in Denmark, Finland, Norway and Sweden comprising men and women aged 25–79 years during 1995–2007. Estimations of alcohol-related mortality were based on underlying and contributory causes of death on individual death certificates, and smoking-related mortality was based on an indirect method that used lung cancer mortality as an indicator for the population-level impact of smoking on mortality. Results About 40%–70% of the between-country differences in life expectancy in the Nordic countries can be attributed to smoking and alcohol. Alcohol-related and smoking-related mortality also made substantial contributions to income differences in life expectancy within countries. The magnitude of the contributions were about 30% in Norway, Sweden and among Finnish women to around 50% among Finnish men and in Denmark. Conclusions Smoking and alcohol consumption make substantial contributions to both between-country differences in mortality among the Nordic countries and within-country differences in mortality by income. The size of these contributions vary by country and sex.Peer reviewe

Income security in Nordic welfare states for men and women who died when aged 55–69 years old

Income security when health impairment or other social risks occur is a major objective of welfare states. This comparative study uses register data from four Nordic welfare states for examining equivalized disposable income during the last 12 years alive among men and women who died when aged 55–69 years old. The analysed outcome indicates the aggregate result of a varied set of income maintenance mechanisms. Median income increased in the Finnish, Norwegian and Swedish samples, but decreased somewhat in Denmark, probably due to relatively frequent transitions to retirement and larger income drops after retirement than in the other Nordic countries. Analyses of comparison samples weighted by propensity scores indicated a better income development among those who lived beyond the observation period than among those who died. The higher educated had a more favourable income development during the years prior to death than those with low education.Peer reviewe

Shape of the association between income and mortality : A cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003

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