Trends in Life Expectancy by Level of Education and Occupational Social Class in Finland 1981-2000

The study analyses trends in life expectancy by level of education and by occupational social class in Finland from 1981 to 2000 to assess to what extent these trends have been in accordance with the target of reducing socioeconomic differences in life expectancy set in the Government public health programme. The study is based on the census records for the population aged 35 or over, which have been linked to the death records for the years 1981 to 2000. The results show that, contrary to the public health target, the difference in the life expectancy between persons with tertiary and basic education and that between upper non-manual and manual occupational classes increased during the 1990s. Differences in the trends in mortality from alcohol-related causes of death and from other cancers than lung cancer accounted for most the increase in the socioeconomic gap among men. Different from the 1980s changes in cardiovascular mortality did not contribute to the increase in the socioeconomic gap. Among women the increase in the socioeconomic gap was mainly due to the heterogeneous group of other diseases and cancers other than lung and breast cance

Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood

Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996–2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.Peer reviewe

Educational differences in all-cause mortality by marital status

Using life table measures, we compare educational differentials in all-cause mortality at ages 40 to 70 in Bulgaria to those in Finland and the United States. Specifically, we assess whether the relationship between education and mortality is modified by marital status. Although high education and being married are associated with lower mortality in all three countries, absolute educational differences tend to be smaller among married than unmarried individuals. Absolute differentials by education are largest for Bulgarian men, but in relative terms educational differences are smaller among Bulgarian men than in Finland and the U.S. Among women, Americans experience the largest education-mortality gradients in both relative and absolute terms. Our results indicate a particular need to tackle health hazards among poorly educated men in countries in transition.all-cause mortality, Bulgaria, educational differentials, Finland, life table measures, marital status, USA

Working life and retirement expectancies at age 50 by social class: period and cohort trends and projections for Finland

The balance between the amount of time spent in work and in retirement underlies the long-term sustainability of the social security system. We examined socioeconomic differences in how increasing longevity is distributed between labor market statuses in Finland

Effects of Individual, Spousal, and Offspring Socioeconomic Status on Mortality Among Elderly People in China

Peer reviewe

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

The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991-2008

To assess the level and changes in contribution of smoking and alcohol-related mortality to educational differences in life expectancy in Sweden. We used register data on the Swedish population at ages 30-74 during 1991-2008. Cause of death was used to identify alcohol-related deaths, while smoking-related mortality was estimated using lung cancer mortality to indirectly assess the impact of smoking on all-cause mortality. Alcohol consumption and smoking contributed to educational differences in life expectancy. Alcohol-related mortality was higher among men and contributed substantially to inequalities among men and made a small (but increasing) contribution to inequalities among women. Smoking-related mortality decreased among men but increased among women, primarily among the low educated. At the end of the follow-up, smoking-related mortality were at similar levels among men and women. The widening gap in life expectancy among women could largely be attributed to smoking. Smoking and alcohol consumption contribute to educational differences in life expectancy among men and women. The majority of the widening in the educational gap in mortality among women can be attributed to alcohol and smoking-related mortality.Peer reviewe

Health-related selection into employment among the unemployed

Background Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability. Methods Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders. Results The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment. Conclusions The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.Peer reviewe

Parental Unemployment and Offspring Psychotropic Medication Purchases : A Longitudinal Fixed-Effects Analysis of 138,644 Adolescents

Parental unemployment is associated with worse adolescent mental health, but prior evidence has primarily been based on cross-sectional studies subject to reverse causality and confounding. We assessed the association between parental unemployment and changes in adolescent psychotropic medication purchases, with longitudinal individual-level fixed-effects models that controlled for time-invariant confounding. We used data from a large, register-based panel of Finnish adolescents aged 13–20 years in 1987–2012 (n = 138,644) that included annual measurements of mothers’ and fathers’ employment and offspring psychotropic medication purchases. We assessed changes in the probability of adolescent psychotropic medication purchases in the years before, during, and after the first episode of parental unemployment. There was no association between mother’s unemployment and offspring psychotropic purchases in the fixed-effects models, suggesting this association is largely driven by unmeasured confounding and selection. By contrast, father’s unemployment led to a significant 15\20\% increase in the probability of purchasing psychotropic medication among adolescents even after extensive controls for observed and unobserved confounding. This change takes at least 1 year to emerge, but it is long-lasting; thus, policies are needed that mitigate the harm of father’s unemployment on offspring’s mental well-being.Parental unemployment is associated with worse adolescent mental health, but prior evidence has primarily been based on cross-sectional studies subject to reverse causality and confounding. We assessed the association between parental unemployment and changes in adolescent psychotropic medication purchases, with longitudinal individual-level fixed-effects models that controlled for time-invariant confounding. We used data from a large, register-based panel of Finnish adolescents aged 13–20 years in 1987–2012 (n = 138,644) that included annual measurements of mothers’ and fathers’ employment and offspring psychotropic medication purchases. We assessed changes in the probability of adolescent psychotropic medication purchases in the years before, during, and after the first episode of parental unemployment. There was no association between mother’s unemployment and offspring psychotropic purchases in the fixed-effects models, suggesting this association is largely driven by unmeasured confounding and selection. By contrast, father’s unemployment led to a significant 15%–20% increase in the probability of purchasing psychotropic medication among adolescents even after extensive controls for observed and unobserved confounding. This change takes at least 1 year to emerge, but it is long-lasting; thus, policies are needed that mitigate the harm of father’s unemployment on offspring’s mental well-being.Peer reviewe