Perinatal health among migrant women : A longitudinal register study in Finland 2000-17

Migrants often have better health than the native-born population ('healthy immigrant effect'), although the effect tends to attenuate over time since migration. However, following the weathering hypothesis, migrants may have worse health due to a combination of discrimination and poorer financial conditions faced by many of them. Yet, little is known about interactions between migrant origin and individual socioeconomic status or the time spent in the host country in relation to reproductive health. We use Finnish register data of 491,532 women and 948,616 births spanning years 2000-17 to longitudinally study the association between the country of birth and perinatal outcomes (preterm birth, unplanned C-section, episiotomy and spontaneous vaginal birth); the interaction of country of birth with household income; and the effect of time since migration using random intercept logistic regression models. We show that a `healthy immigrant effect' largely does not exist for perinatal outcomes apart from migrants from a few high-income countries. Instead, in particular women from poorer countries tended to fare worse than native women. Often, the effect of the country of birth did not differ by household income, or the patterns were not clear. The impact of time since immigration was complex and dependent on country of birth and the outcome studied, but showed an increase in risk of preterm birth among migrants from low- and lower-middle-income countries compared to those born in Finland. Discrimination, language barriers in seeking care or refugee experiences are among some of the possible mechanisms explaining the worse perinatal health of migrants from poorer countries. The inequalities observed in a global scale in countries' economic outcomes may reproduce themselves as reproductive health inequalities among migrants living in wealthy countries.Peer reviewe

Social Determinants of Mortality from Childhood to Early Adulthood

Social gradients in health, wherein each successive level of social position enjoys better health and lower mortality, have been observed in various health indicators within different societies. Social inequalities in infant and adult mortality are well documented, but previous findings on children, adolescents and young adults are less complete and less consistent. Death at a young age is increasingly rare in developed countries. Nevertheless, research on mortality can still provide valuable insights into health inequalities in that social differentials in ultimate health outcomes reflect differentials in many other acute and chronic health conditions that are more difficult to capture. The purpose of this study was to examine the social determinants of mortality at a young age. The findings are based on several measures of parental social background, and among older adolescents and young adults also on measures reflecting their own social position and current living arrangements. Extensive individual-level register data was obtained from Statistics Finland. Combining longitudinal population census and employment data from the period 1970 2007 with data on mortality and causes of death, the study data covered 80% of all deaths in 1990−2007. Social differentials in mortality in the age range 1−29 years were assessed in both absolute and relative terms, by calculating mortality rates and estimating Cox proportional hazards models. Mortality in childhood among both boys and girls was clearly associated with family type and parental socioeconomic factors. There were no differences in mortality between children in cohabiting-parent families and children of married parents, but children in single-parent families carried an excess risk. Both parental education and household income showed clear mortality gradients, with higher mortality among children of parents with lower levels of education and who earned less. The relationship between single parenthood and child mortality was, in fact, largely attributable to the associated low parental education and income. Mortality in late adolescence and early adulthood was higher among young men and women living in single- or cohabiting-parent families, as single parents themselves, alone, or with others than among those living in the parental home with married parents. Living independently with a partner was associated with lower mortality, especially among people in their late 20s. Following adjustment for childhood and current factors, the strongest excess mortality in early adulthood occurred among the less-highly educated and the non-employed. Leaving the parental home at a young age also remained an independent risk factor for premature death. The associations between parental social background and mortality were distinct but smaller, and were largely mediated by the current factors and age at leaving the parental home. Among children, social inequalities in mortality were strongest in early childhood, between the ages of one and four years, somewhat smaller between five and nine years, and with the exception of a weak association between mortality and parental education, non-existent at 10 14 years. Moreover, the associations between mortality and the current living arrangements and the main activity differed by age in late adolescence and early adulthood. The convergence of social differentials in mortality in late childhood, and their re-emergence in late adolescence related to changes in the most common causes of death during these life phases. Influenced by various factors, different causes of death are more or less likely to associate with social factors. Social differentials in mortality stemmed mostly from external causes, but deaths from diseases contributed to mortality differentials between the ages of one to four, and in early adulthood. Targeting support to high-risk groups in early childhood and in the transition to adulthood could prove to be effective in reducing health inequalities and preventing social exclusion not only among the young but also later in life.Sosiaaliset ja taloudelliset olosuhteet ovat merkittäviä tekijöitä väestöryhmien välisten terveys- ja kuolleisuuserojen taustalla. Aikuisväestöä ja imeväisikäisiä koskevaan tutkimustietoon verrattuna lasten, nuorten ja nuorten aikuisten terveys- ja kuolleisuuseroja ja niiden taustoja tunnetaan kuitenkin selvästi heikommin. Tämän tutkimuksen tavoitteena oli tuottaa kattava kuvaus väestöryhmittäisistä eroista kuolleisuudessa ikävälillä 1−29. Tutkimuksessa tarkasteltiin lapsuudenperheen rakenteen ja sosioekonomisen aseman sekä nuorten aikuisten osalta myös heidän oman sosiaalisen asemansa ja asumismuotonsa yhteyksiä kuolleisuuteen. Tutkimusaineisto perustuu Tilastokeskuksen ylläpitämiin valtakunnallisiin rekistereihin, joista yksilö- ja kotitalouskohtaisia väestölaskenta- ja työllisyystietoja on yhdistetty kuolleisuustietoihin aikavälillä 1990−2007. Perheen sosioekonominen asema ja perherakenne olivat selkeästi yhteydessä lasten kuolleisuuteen. Avio- ja avoliittoperheiden välillä ei havaittu eroja, mutta yksinhuoltajien lapsilla kuolleisuus oli sekä pojilla että tytöillä selvästi kahden vanhemman perheitä korkeampaa. Vanhempien koulutuksen ja tulojen mukaiset kuolleisuuserot olivat vielä voimakkaampia; lasten ylikuolleisuus yksinhuoltajaperheissä olikin pitkälti sidoksissa yksinhuoltajavanhempien alempaan koulutustasoon ja pienempiin tuloihin. Nuorten miesten ja naisten (17−29-v.) kuolleisuus oli korkeampaa avoliitto- ja yksinhuoltajaperheissä asuvilla, yksinhuoltajilla sekä yksin tai muiden kuin puolison kanssa asuvilla verrattuna yhä lapsuudenkodissa, naimisissa olevien vanhempiensa kanssa asuviin. Korkein ennenaikaisen kuoleman riski oli kuitenkin vähän koulutetuilla ja ei-työllisillä nuorilla. Lapsuusajan perherakenteen ja vanhempien sosioekonomisen aseman yhteydet kuolleisuuteen välittyivät pitkälti nuorten oman sosiaalisen aseman, lapsuudenkodista muuton ajoittumisen sekä nykyisen asumismuodon kautta. Aikainen lapsuudenkodista muuttaminen osoittautui myös itsenäiseksi kuolleisuuden riskitekijäksi. Väestöryhmittäiset erot olivat selkeimpiä ulkoisissa kuolinsyissä, mutta eroja havaittiin myös tautikuolleisuudessa. Suhteelliset kuolleisuuserot olivat suurimmillaan nuorimmilla lapsilla (1−4-v.) ja nuorilla aikuisilla, kun taas 10−14-vuotiailla erot kuolleisuudessa olivat lähes olemattomat. Yhteiskunnan haavoittuvimmille ryhmille osoitetun tuen kohdentaminen raskausaikaan ja varhaislapsuuteen sekä toisaalta teini-iässä alkavaan aikuistumisvaiheeseen voisi tehokkaasti edistää terveys- ja kuolleisuuserojen kaventumista ja ehkäistä syrjäytymistä niin nuoruudessa kuin myöhemmälläkin iällä

Suomen yhteiskuntaluokat 1980-2000

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Yhteiskuntaluokka on nykysosiologiassa vahvasti kyseenalaistettu ja toisaalta usein myös unohdettu käsite. Tutkielmassa tarkastellaan luokan käsitteen soveltuvuutta nyky-yhteiskunnan rakenteen hahmottamiseen. Tutkielman taustalla on vuonna 1985 ilmestynyt kirja Suomalaiset – yhteiskunnan rakenne teollistumisen aikana, jossa Risto Alapuro ja Matti Alestalo kartoittavat Suomen luokkarakennetta 1870-luvulta 1980-luvulle asti. Tässä työssä tarkoituksena oli jatkaa Suomen luokkarakenteen kuvaamista vuodesta 1980 vuoteen 2000, joskin Suomalaiset-kirjaa selvästi suppeammalla tasolla. Suomen luokkarakenteen kehitystä aikavälillä 1980–2000 tarkastellaan Tilastokeskuksen sosioekonomisen aseman luokittelun avulla. Aineistoina toimivat otokset Tilastokeskuksen väestölaskennan ja työssäkäyntitilastojen pitkittäisaineistoihin perustuvista Eksy95- ja Eksy01-aineistoista. Molemmat aineistot ovat yksilötasoisia rekisteriaineistoja. Sosioekonomisen aseman yhteyttä muihin tekijöihin tarkastellaan pääasiallisesti ristiintaulukoinnin avulla. Tutkielmassa pyrittiin selvittämään miten Suomen luokkarakenne on muuttunut aikavälillä 1980–2000 ja mitkä ovat keskeiset syyt muutoksiin. Lisäksi huomion kohteena oli sosioekonomisen aseman vaikutus yksilöiden elämän mahdollisuuksiin, joita tarkasteltiin tulojen, asuinolojen ja työttömyyden riskin avulla. Yleisenä tavoitteena oli myös arvioida Tilastokeskuksen sosioekonomisen aseman luokittelun soveltuvuutta luokkarakenteen kuvaamiseen. Tämän työn tulosten perusteella 1980- ja 1990-luvun Suomen luokkarakenteessa näkyi jo aiemmin alkaneiden kehityskulkujen eteneminen. Maatalousväestö jatkoi vähenemistään, ja samalla pieneni myös työntekijöiden osuus merkittävästi. Toimihenkilöistymiskehitys jatkui palvelusektorin edelleen laajentuessa, tosin entistä vahvemmin ylempiin toimihenkilöihin painottuneena. Poikkeuksellisena luokkarakenteen kehityksessä erottuu 1990-luvun alun taloudellisen taantuman myötä aiempaa laajempiin mittoihin kasvanut työttömyys, joka kasvatti ammatissa toimimattoman väestön osuutta huomattavasti. Suomen luokkarakenteen tarkastelu sosioekonomisen aseman luokittelun avulla toi esiin selviä, johdonmukaisesti tulkittavissa olevia eroja sosioekonomisten ryhmien välillä, mikä osoittaa mielestäni luokan käsitteen edelleen vahvan selitysvoiman nyky-yhteiskunnan rakenteiden tutkimuksessa. Luokitukseen liittyy kuitenkin luokka-analyysin kannalta selviä rajoitteita ja ongelmia, joihin jatkossa tulisi etsiä ratkaisua. Työssä tuli myös selvästi esiin muiden yhteiskunnallisten jakojen merkitys yksilön elämän mahdollisuuksille, joiden yhteisvaikutus luokan kanssa tulisi ottaa luokkatutkimuksessakin paremmin huomioon

Socioeconomic differences in psychiatric treatment before and after self-harm : an observational study of 4,280 adolescents and young adults

Background: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. Methods: The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. Results: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and low- est probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. Conclusions: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.Peer reviewe

Early Adolescent Health Problems, School Performance, and Upper Secondary Educational Pathways : A Counterfactual-Based Mediation Analysis

Peer reviewe

Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition

Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.Peer reviewe

The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education

Objectives To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. Study design A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Results Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. Conclusions More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.Peer reviewe

Evaluating the Role of Parental Education and Adolescent Health Problems in Educational Attainment

This article reconsiders the role of social origin in health selection by examining whether parental education moderates the association between early health and educational attainment and whether health problems mediate the intergenerational transmission of education. We used longitudinal register data on Finns born in 1986–1991 (n = 352,899). We measured the completion of secondary and tertiary education until age 27 and used data on hospital care and medication reimbursements to assess chronic somatic conditions, frequent infections, and mental disorders at ages 10–16. We employed linear probability models to estimate the associations between different types of health problems and educational outcomes and to examine moderation by parental education, both overall in the population and comparing siblings with and without health problems. Finally, we performed a mediation analysis with g-computation to simulate whether a hypothetical eradication of health problems would weaken the association between parental and offspring education. All types of health problems reduced the likelihood of secondary education, but mental disorders were associated with the largest reductions. Among those with secondary education, there was further evidence of selection to tertiary education. High parental education buffered against the negative impact of mental disorders on completing secondary education but exacerbated it in the case of tertiary education. The simulated eradication of health problems slightly reduced disparities by parental education in secondary education (up to 10%) but increased disparities in tertiary education (up to 2%). Adolescent health problems and parental education are strong but chiefly independent predictors of educational attainment.Peer reviewe

Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood

Introduction Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. Methods The study uses administrative register data on a 20% random sample of Finnish households with children aged 0–14 years in 2000. We follow children born in 1986–1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. Results The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. Conclusions Our findings suggest that both parents’ adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.Peer reviewe