Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015 : a register-based study

This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 among 30-74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000-2003 and 2012-2015. From 2004-2007 to 2008-2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000-2003 to 2012-2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.Peer reviewe

Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000–2015 : a register-based study

Publisher Copyright: © 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.Aim: To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland. Design: Longitudinal register-based follow-up study. Setting: Estonia, Latvia, Lithuania and Finland. Participants: General population in the 35–74 age group. Measurements: Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0–2), middle (3–4), and high (5–8). Educational inequalities in alcohol-related mortality in 2000–2003, 2004–2007, 2008–2011 and 2012–2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality. Findings: Alcohol-related mortality increased in all countries in 2004–2007 except among Estonian women and decreased/remained the same from 2008 onward except among Latvian men. By 2012–2015 alcohol-related mortality was still higher than in 2000–2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004–2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008–2011 and in 2012–2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012–2015 versus 2000–2003 in all countries except Estonia (decrease). Conclusion: In the Baltic countries and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004–2007) and decrease more among the high educated during a period of economic recession (2008–2011).Peer reviewe

Educational inequalities in epilepsy mortality in the Baltic countries and Finland in 2000–2015

Little is known about socioeconomic diferences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000–2015. Education-specifc mortality estimates for individuals aged 30–74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data fle of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000–2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000–2007 widened in 2008–2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000–2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000–2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.Little is known about socioeconomic differences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000-2015. Education-specific mortality estimates for individuals aged 30-74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data file of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000-2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000-2007 widened in 2008-2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000-2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000-2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.Peer reviewe

Economic fluctuations and long-term trends in depression : a repeated cross-sectional study in Estonia 2004-2016

BACKGROUND: In the 2000s, the Baltic countries experienced unprecedented credit-driven economic growth that was followed by a deep recession. This study examined the impact of profound macroeconomic changes on population mental health in Estonia in 2004-2016. METHODS: Data on 17 794 individuals in the 20-64 age group were obtained from seven nationally representative cross-sectional surveys. The prevalence of past 30-day depression was calculated for men and women further stratified by sociodemographic characteristics. Multivariable regression analysis was used to assess whether these characteristics were associated with the yearly variation in depression. RESULTS: In 2006, the adjusted prevalence ratio for depression was 0.77 (95% CI 0.64 to 0.93) for men and 0.85 (95% CI 0.74 to 0.97) for women as compared with 2004; in 2010, the prevalence ratio as compared with 2008 for both men and women was 1.22 (95% CIs 1.04 to 1.43 and 1.09 to 1.37, respectively). Among men, the increase in the prevalence of depression in 2008-2010 was statistically significant for 35-64 year olds, ethnic Estonians, those who were married, mid-educated or were employed, whereas among women, a significant increase was observed in 50-64 year olds, Estonians and non-Estonians, those who were not-married, were highly educated or mid-educated, in the mid-income group or were employed. CONCLUSIONS: Population mental health is responsive to macroeconomic changes. In less wealthy high-income countries, the greater impact of recession on depression among advantaged groups may relate to a higher debt burden coupled with job insecurity

Homicide in post-Soviet Belarus: urban-rural trends

alcohol, Belarus, homicide, poverty, rural, urbanBackground: To investigate the occurrence of homicide in urban and rural regions of Belarus in the post-Soviet period. Methods: All-age male and female homicide mortality and population data were obtained for the years 1990, 1995, 2000 and 2005 for urban and rural regions of Belarus. These data were recalculated into three age categories and directly standardised. To assess relative changes in rural-urban homicide rates across time Poisson regression models were used to calculate rate ratios. Results: Between 1990 and 1995 homicide rates rose sharply in urban and rural regions although the rise was greater in the former. Although there was little change in homicide rates in 2000, a notable divergence had occurred by 2005. While homicide rates rose slightly in rural areas, a large fall occurred in the rates of both men and women in urban areas. This resulted in significantly higher rural homicide rate ratios at the end of the study period. With some variations age-specific homicide rates followed this overall general pattern resulting in significantly higher homicide rate ratios in all rural groups aged 15 and above in 2005. Conclusion: It is probable that a combination of factors such as high levels of poverty, the effects of alcohol consumption, as well as the poor provision of emergency medical services underlie both the high levels of lethal violence and the growing rural-urban divergence in homicide rates in contemporary Belarus. Urgent action is now needed to address the deteriorating social and economic conditions underpinning violence, especially in rural regions

Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000-2015 : A register-based study

Introduction: In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. This study aimed to examine changes and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in relation to macroeconomic fluctuations. Methods: We analysed changes in overall suicide mortality and by educational level between the 2000-2003, 2004-2007, 2008-2011 and 2012-2015 periods among men aged 30-64 years using census-linked longitudinal mortality data. We estimated age-standardised mortality rates, mortality rate ratios (Poisson regression), the relative index of inequality and slope index of inequality. Results: Overall suicide mortality fell markedly from 2000-2003 to 2004-2007. The decline was largest among high educated men in the Baltic countries and among middle and low educated men in Finland. From 2004-2007 to 2008-2011, the positive trend slowed and while suicide mortality continued to fall among middle and low educated men, it increased somewhat among high educated men in all Baltic countries. In Finland, suicide mortality decreased among the high educated and increased slightly among low educated men. Conclusions: In the Baltic countries, lower educated men had a smaller decline in suicide mortality than higher educated men during a period of rapid economic expansion, however, they were not more disadvantaged during the recession, possibly because of being less exposed to financial loss. Consequently, relative inequalities in suicide mortality may increase during economic booms and decrease during recessions.Peer reviewe

Economic fluctuations and urban-rural differences in educational inequalities in mortality in the Baltic countries and Finland in 2000-2015 : a register-based study

We examined urban-rural differences in educational inequalities in mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in the context of macroeconomic changes. Educational inequalities among 30-74 year olds were examined in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 using census-linked longitudinal mortality data. We estimated age-standardized mortality rates and the relative and slope index of inequality. Overall mortality rates were larger in rural areas except among Finnish women. Relative educational inequalities in mortality were often larger in urban areas among men but in rural areas among women. Absolute inequalities were mostly larger in rural areas excepting Finnish men. Between 2000-2003 and 2012-2015 relative inequalities increased in most countries while absolute inequalities decreased except in Lithuania. In the Baltic countries the changes in both relative and absolute inequalities tended to be more favorable in urban areas; in Finland they were more favorable in rural areas. The overall pattern changed during the reccessionary period from 2004-2007 to 2008-2011 when relative inequalities often diminished or the increase slowed, while the decrease in absolute inequalities accelerated with larger improvements observed in urban areas. Despite substantial progress in reducing overall mortality rates in both urban and rural areas in all countries, low educated men and women in rural areas in the Baltic countries are becoming increasingly disadvantaged in terms of mortality reduction.Peer reviewe

Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004–2012: a repeated cross-sectional study

Abstract Background The aim of this study was to assess trends and inequalities in dental care utilization in Estonia and Lithuania in relation to large-scale macroeconomic changes in 2004–2012. Methods Data on 22,784 individuals in the 20–64 age group were retrieved from nationally representative cross-sectional surveys in 2004, 2006, 2008, 2010 and 2012. Age- and sex-standardized prevalence estimates of past 12-month dental visits were calculated for each study year, stratified by gender, age group, ethnicity, educational level and economic activity. Multivariable logistic regression analysis was used to assess the independent effect of study year and socioeconomic status on dental visits. Results The age- and sex-standardized prevalence of dental visits in the past 12 months was 46–52% in Estonia and 61–67% in Lithuania. In 2004–2008, the prevalence of dental visits increased by 5.9 percentage points in both countries and fell in 2008–2010 by 3.8 percentage points in Estonia and 4.6 percentage points in Lithuania. In both countries the prevalence of dental care utilization had increased slightly by 2012, although the increase was statistically insignificant. Results from a logistic regression analysis showed that these differences between study years were not explained by differences in socioeconomic status or oral health conditions. Women, the main ethnic group (only in Estonia), and higher educated and employed persons had significantly higher odds of dental visits in both countries, but the odds were lower for 50–64 year olds in Lithuania. Conclusions In European Union countries with lower national wealth, the use of dental services is sensitive to macroeconomic changes regardless of the extent of public coverage, at the same time, higher public coverage may not relate to lower inequalities in dental care use

Loneliness and health in Eastern Europe: findings from Moscow, Russia.

OBJECTIVES: To examine which factors are associated with feeling lonely in Moscow, Russia, and to determine whether loneliness is associated with worse health. STUDY DESIGN: Cross-sectional study. METHODS: Data from 1190 participants were drawn from the Moscow Health Survey. Logistic regression analysis was used to examine which factors were associated with feeling lonely and whether loneliness was linked to poor health. RESULTS: Almost 10% of the participants reported that they often felt lonely. Divorced and widowed individuals were significantly more likely to feel lonely, while not living alone and having greater social support reduced the risk of loneliness. Participants who felt lonely were more likely to have poor self-rated health (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.38-3.76), and have suffered from insomnia (OR: 2.43; CI: 1.56-3.77) and mental ill health (OR: 2.93; CI: 1.88-4.56). CONCLUSIONS: Feeling lonely is linked to poorer health in Moscow. More research is now needed on loneliness and the way it affects health in Eastern Europe, so that appropriate interventions can be designed and implemented to reduce loneliness and its harmful impact on population well-being in this setting