Changing associations between partnership history and risk of accidents, violence and suicides

Peer reviewe

Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke

Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse's death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse's death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse's death from stroke.Peer reviewe

Contribution of smoking-attributable mortality to life expectancy differences by marital status among Finnish men and women, 1971-2010

BACKGROUND Smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed Finnish men and women aged 50 years and above in 1971-2010. DATA AND METHODS The data sets cover all persons permanently living in Finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes. RESULTS Life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971-1975 37-48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11-18% by 2006-2010. Among women, in 1971-1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10-29% in 2006-2010. CONCLUSIONS In recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.Peer reviewe

Partner resources and incidence and survival in two major causes of death

Because people tend to marry social equals – and possibly also because partners affect each other’s health – the social position of one partner is associated with the other partner’s health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner’s resources are of most significance. This article addresses the importance of partner’s education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner’s education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner’s education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner’s employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner’s history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner’s characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner’s social resources, is needed.Peer reviewe

The Well-Being of Adolescents Conceived Through Medically Assisted Reproduction : A Population-Level and Within-Family Analysis

Medically assisted reproduction (MAR) plays an increasingly important role in the realization of fertility intentions in advanced societies, yet the evidence regarding MAR-conceived children’s longer-term well-being remains inconclusive. Using register data on all Finnish children born in 1995–2000, we compared a range of social and mental health outcomes among MAR- and naturally conceived adolescents in population-averaged estimates, and within families who have conceived both through MAR and naturally. In baseline models, MAR-conceived adolescents had better school performance and the likelihood of school dropout, not being in education or employment, and early home-leaving were lower than among naturally conceived adolescents. No major differences were found in mental health and high-risk health behaviours. Adjustment for family sociodemographic characteristics attenuated MAR adolescents’ advantage in social outcomes, while increasing the risk of mental disorders. The higher probability of mental disorders persisted when comparing MAR adolescents to their naturally conceived siblings. On average, MAR adolescents had similar or better outcomes than naturally conceived adolescents, largely due to their more advantaged family backgrounds, which underscores the importance of integrating a sociodemographic perspective in studies of MAR and its consequences.Peer reviewe

Turvakotipalvelujen kansalliset laatusuositukset

Turvakotipalvelut ovat yksi lähisuhdeväkivaltaa kokeneiden tarvitsemista palveluista. Avopalvelut ovat tärkeitä lähisuhdeväkivaltaa ennaltaehkäisevänä palveluna sekä tukena esimerkiksi turvakotijakson jälkeen. Lähisuhdeväkivallan ehkäisytyössä on tärkeää tiivis ja toimiva yhteistyö turvakotipalvelujen ja avopalveluiden välillä. Terveyden ja hyvinvoinnin laitoksen (THL) tehtävänä on huolehtia turvakotitoiminnan ohjauksesta, arvioinnista, kehittämisestä ja palveluiden valtakunnallisesta yhteensovittamisesta. Uusilla laatusuosituksilla THL vastaa muuttuneen lainsäädännön asettamiin vaatimuksiin ja nykymuotoisten turvakotipalveluiden kehittämiseen. Lisäksi laatusuosituksilla halutaan vaikuttaa turvakotipalveluiden yhteneväisyyteen palveluverkon kasvaessa

Sosiaaliryhmien elinajanodote-erojen kasvu on pääosin pysähtynyt

Lähtökohdat Koulutusryhmien ja etenkin tuloryhmien väliset sosioekonomiset erot elinajanodotteessa kasvoivat merkittävästi v. 1988–2007. Kasvu johtui pääasiassa alimman tuloviidenneksen elinajanodotteen epäsuotuisasta kehityksestä alkoholikuolleisuuden lisäännyttyä. Menetelmät Tutkimus perustuu Tilastokeskuksen väestörekisteriaineistoihin ja kattaa Suomessa v. 1996–2014 asuneet henkilöt. 25-vuotiaiden elinajanodotteet laskettiin vuosittain ja neljän vuoden jaksoissa miehille ja naisille tuloviidenneksittäin ja koulutusryhmittäin. Elinajanodotteiden erot ja muutokset sosiaaliryhmittäin analysoitiin ikäluokan ja kuolemansyyn mukaan jaksoilta 2006–09 ja 2011–14. Tulokset Ylimmän ja alimman tulo- ja koulutusryhmän elinajanodotteen erojen kasvu on pysähtynyt ja jopa kaventui hieman 2010-luvulla lukuun ottamatta naisten eroja koulutusryhmittäin. Alimman tuloviidenneksen elinajanodote lähti jälleen kasvuun 2010-luvulla, kun alkoholiperäinen, tapaturmainen ja väkivaltainen kuolleisuus väheni alimmissa sosiaaliryhmissä etenkin miehillä. Naisilla erot syöpäkuolleisuudessa ovat yhä kasvaneet. Päätelmät Erot elinajanodotteessa ovat yhä suuret, vaikka tulo- ja koulutusryhmien ero kaventui hieman. ¬Alkoholikuolleisuuden vähenemisellä oli suuri merkitys erojen kaventumiseen etenkin miehillä. Kuolleisuuserot saattavat selvästi pienentyä, jos alimmissa sosiaaliryhmissä edistetään alkoholiperäisistä ja iskeemisistä sydänsairauksista johtuvan kuolleisuuden vähenemistä.Peer reviewe

The burden of diabetes mortality in Finland 1988-2007-A brief report

Background: Increasing incidence of diabetes has been reported in many countries and the disease burden related to diabetes to be distributed unevenly across the population. Patients with lower socioeconomic position have been reported to have higher diabetes prevalence, higher rates of diabetes related complications and excess mortality. This study examined trends in gender, age and socioeconomic differences in the burden of diabetes mortality in the Finnish population aged 35-80 and potential years of life lost (PYLL) due to diabetes. Methods: The data consist of an 11% random sample of Finnish residents in 1987-2007 and an 80% oversample of persons who died during those years. We examined diabetes both as underlying and contributory cause. We calculated age-specific and age-standardized diabetes death rates by gender and socioeconomic position using the direct method and PYLL due to diabetes related deaths for 2004-2007. Results: Diabetes related mortality was higher among older Finns. A clear and systematic socioeconomic pattern was detected among both men and women: the higher the socioeconomic position the lower the mortality. The contribution of diabetes to PYLL was 8% among men and 6% among women. Among women, the contribution of diabetes to PYLL was lower in higher socioeconomic groups, whereas among men, the contribution was similar in all socioeconomic groups. Conclusions: In order to further reduce the burden of diabetes a better treatment balance to prevent diabetes complications would significantly decrease the burden of diabetes mortality. Use of underlying and contributory causes of death is useful in monitoring trends and sub-group differences in the burden of diabetes.Peer reviewe

The contribution of health policy and care to income differences in life expectancy - a register based cohort study

BACKGROUND:Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland.METHODS:The study data were based on an 11% random sample of Finnish residents in 1988-2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group.RESULTS:Overall, the difference in e35 between the extreme income deciles was 11.6years among men and 4.2years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4years among men and 1.7years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences.CONCLUSIONS:The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.Peer reviewe

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

BACKGROUND: Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS: We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS: We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982–2008; Finnish women, 1985–2017; and Italian men, 1976–1999) were driven by faster mortality declines among the high-educated aged 65–84, and by mortality increases among the low-educated aged 30–59. The long-term decreases (British men, 1976–2008, and Italian women, 1972–2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30–54. CONCLUSION: Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30