Jan Saarela

The Forgotten Griever: A Nationwide Follow-up Study of Mortality Subsequent to the Death of a Sibling

Previous findings have suggested that the loss of a family member is associated with mortality among bereaved family members. The least-studied familial relationship in the bereavement literature is that of siblings, although loss of a sibling may also involve health consequences. The authors conducted a follow-up study based on data from the Swedish total population register, covering the period 1981-2002. Using Cox regression, mortality risk ratios for bereaved and nonbereaved persons aged 18-69 years were estimated. All-cause mortality and cause-specific mortality (unnatural causes, natural causes, cardiovascular disease, cancer, suicide, accidents, and all other causes) were examined. In men, the mortality risk for bereaved persons versus nonbereaved persons was 1.26 (95% confidence interval: 1.22, 1.30), and in women it was 1.33 (95% confidence interval: 1.28, 1.39). An elevated mortality risk associated with a siblings death was found in all age groups studied, but the association was generally stronger at younger ages and could be observed predominantly after more than 1 year of follow-up. There was also an increased mortality risk if the sibling had died from a discordant main cause, which may strengthen the possibility that the association observed is not due to confounding alone.

Unemployment and native language: the Finnish case

This paper explores the reasons behind the lower unemployment rate of the Swedish-speaking minority, in comparison with that of the Finnish-speaking majority, in Finland. Cross section statistics on labour market status and outflows from unemployment are analysed. No significant between-group differences in labour force participation are found. Differences in unemployment cannot either be explained by human capital factors or local labour market conditions. Being a Swedish-speaker decreases the odds of being unemployed by 30%, while it increases the transition rate from unemployment by 15%. Language proficiency and social integration are the likely reasons behind these differences.

Parental death during childhood and subsequent school performance.

OBJECTIVES: Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality. METHODS: This was a register-based national cohort study of 772 117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1–5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as β-coefficients and odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Parental death was associated with lower grades (ORs: –0.21 [95% CI: –0.23 to –0.20] and –0.17 [95% CI: –0.19 to –0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: –0.27 [90% CI: –0.28 to –0.26]), compared with natural deaths (OR: –0.16 [95% CI: –0.17 to –0.15]), was not seen after adjustment for SEP and psychosocial situation of the family. CONCLUSIONS: Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.

Mortality From Myocardial Infarction After the Death of a Sibling: A Nationwide Follow‐up Study From Sweden

Background Death of a sibling represents a stressful life event and could be a potential trigger of myocardial infarction (MI). We studied the association between loss of an adult sibling and mortality from MI up to 18 years after bereavement. Methods and Results We conducted a follow‐up study for Swedes aged 40 to 69 years between 1981 and 2002, based on register data covering the total population (N=1 617 010). Sibling deaths could be observed from 1981 and on. An increased mortality rate from MI was found among women (1.25 CI 1.02 to 1.54) and men (1.15 CI 1.03 to 1.28) who had experienced death of an adult sibling. An elevated rate some years after bereavement was found among both women (during the fourth to sixth half‐years after the death) and men (during the second to sixth half‐years after the death), whereas limited support for a short‐term elevation in the rate was found (during the first few months since bereavement). External causes of sibling death were associated with increased MI mortality among women (1.54 CI 1.07 to 2.22), whereas nonexternal causes showed associations in men (1.23 CI 1.09 to 1.38). However, further analyses showed that if the sibling also died from MI, associations were primarily found among both women (1.62 CI 1.00 to 2.61) and men (1.98 CI 1.59 to 2.48). Conclusions Our study provided the first large‐scale evidence for mortality from MI associated with the death of a sibling at an adult age. The fact that findings suggested associations primarily between concordant causes of death (both died of MI) could indicate genetic resemblance or shared risk factors during childhood. Future studies on bereavement should carefully deal with the possibility of residual confounding.

Mortality inequality in two native population groups

A sample of people aged 40–67 years, taken from a longitudinal register compiled by Statistics Finland, is used to analyse mortality differences between Swedish speakers and Finnish speakers in Finland. Finnish speakers are known to have higher death rates than Swedish speakers. The purpose is to explore whether labour-market experience and partnership status, treated as proxies for measures of variation in health-related characteristics, are related to the mortality differential. Persons who are single, disability pensioners, and those having experienced unemployment are found to have substantially higher death rates than those with a partner and employed persons. Swedish speakers have a more favourable distribution on both variables, which thus notably helps to reduce the Finnish–Swedish mortality gradient. A conclusion from this study is that future analyses on the topic should focus on mechanisms that bring a greater proportion of Finnish speakers into the groups with poor health or supposed unhealthy behaviour.

Fatal Stroke after the Death of a Sibling: A Nationwide Follow-Up Study from Sweden

Background Although less studied than other types of familial losses, the loss of a sibling could be a potential trigger of stroke as it represents a stressful life event. We studied the association between loss of a sibling and fatal stroke up to 18 years since bereavement. Methodology/Principal Findings We conducted a follow-up study between 1981 and 2002, based on register data covering the total population of Swedes aged 40–69 years (n = 1,617,010). An increased risk of fatal stroke (1.31 CI: 1.05, 1.62) was found among women who had experienced the loss of a sibling. No increase in the overall mortality risk was found in men (1.11 CI: 0.92, 1.33). An elevated risk in the short term (during the second and third half-year after the death) was found among both men and women, whereas longer-term elevation in risk was found primarily for women. Both external (1.47 CI: 1.00, 2.17) and not external (1.26 CI: 1.00, 1.60) causes of sibling death showed associations among women. In men, an association was found only if the sibling also died from stroke (1.78 CI: 1.00, 3.17). However, among women, we found an increased risk of stroke mortality if the sibling died from causes other than stroke (1.30 CI: 1.04, 1.62). Conclusions/Significance The findings suggest an increased risk of dying from stroke mortality after the death of a sibling, and that bereavement affects particularly women. It is important for health care workers to follow bereaved siblings and recognize potential changes of stress-levels and health related behaviours that could lead to risk of stroke.

Suicide following the death of a sibling: a nationwide follow-up study from Sweden.

Objectives The death of a sibling can trigger grief and depression. Sibling deaths from external causes may be particularly detrimental, since they are often sudden. We aimed to examine the association between the death of an adult sibling from external causes and the risk of suicide among surviving siblings up to 18 years after bereavement. We adjusted for intrafamily correlation in death risks, which might occur because of shared genetics and shared early-life experiences of siblings in the same family. Design A follow-up study between 1981 and 2002 based on the total population. Setting Sweden. Participants Swedes aged 25–64 years (n=1 748 069). Primary and secondary outcome measures Suicide from the Swedish cause of death register. Results An increased risk of mortality from suicide was found among persons who had experienced the death of a sibling. In women, the suicide risk was 1.55 times that of non-bereaved persons (95% CI 0.99 to 2.44), and in men it was 1.28 times higher (95% CI 0.93 to 1.77). If one sibling committed suicide, the risk of the remaining sibling also committing suicide was 3.19 (95% CI 1.23 to 8.25) among women and 2.44 (95% CI 1.34 to 4.45) among men. Associations with other main causes of death—such as external other than suicide, cardiovascular diseases or cancer—were generally much smaller and statistically not significant in either sex. We found no clear support for a specific time pattern according to time since a siblings death. Conclusions Our study provided evidence for suicide risk associated with the death of a sibling at adult age, revealing that bereaved persons’ risk of suicide is higher when siblings die from suicide, even when adjusting for intrafamily correlation in death risks.

Forced Migration and Mortality in the Very Long Term: Did Perestroika Affect Death Rates Also in Finland?

In this article, we analyze mortality rates of Finns born in areas that were ceded to the Soviet Union after World War II and from which the entire population was evacuated. These internally displaced persons are observed during the period 1971-2004 and compared with people born in the same region but on the adjacent side of the new border. We find that in the 1970s and 1980s, the forced migrants had mortality rates that were on par with those of people in the comparison group. In the late 1980s, the mortality risk of internally displaced men increased by 20% in relation to the expected time trend. This deviation, which manifests particularly in cardiovascular mortality, coincides with perestroika and the demise of the Soviet Union, which were events that resulted in an intense debate in civil society about restitution of the ceded areas. Because state actors were reluctant to engage, the debate declined after some few years, and after the mid-1990s, the death risk again approached the long-term trend. Our findings indicate that when internally displaced persons must adjust to situations for which appropriate coping behaviors are unknown, psychosocial stress might arise several decades after their evacuation.

Transitions within and from ethno-linguistically mixed and endogamous first unions in Finland

Utilizing longitudinal population register data from Finland, this study examines the influence of exogamy on transitions within and from first unions. The aim is to assess how ethno-linguistically mixed unions, consisting of Swedish speakers and Finnish speakers, differ from endogamous unions with respect to various transitions in the family formation process subsequent to entry into childless cohabitation. We find evidence of notable selection. The proportion of endogamous relationships increases during the course of the courtship process, and this selection is primarily driven by a higher separation risk of ethno-linguistically mixed unions. The stages in family formation consequently seem to work as a social filter, where the exogamy effect on the dissolution risk is particularly strong for couples who have come a long way in the process.

Birth Order and Suicide in Adulthood: Evidence From Swedish Population Data

Each year, almost 1 million people die from suicide, which is among the leading causes of death in young people. We studied how birth order was associated with suicide and other main causes of death. A follow-up study based on the Swedish population register was conducted for sibling groups born from 1932 to 1980 who were observed during the period 1981-2002. Focus was on the within-family variation in suicide risk, meaning that we studied sibling groups that consisted of 2 or more children in which at least 1 died from suicide. These family-fixed effects analyses revealed that each increase in birth order was related to an 18% higher suicide risk (95% confidence interval (CI): 1.14, 1.23, P = 0.000). The association was slightly lower among sibling groups born in 1932-1955 (hazard ratio = 1.13, 95% CI: 1.06, 1.21, P = 0.000) than among those born in 1967-1980 (hazard ratio = 1.24, 95% CI: 0.97, 1.57, P = 0.080). Further analyses suggested that the association between birth order and suicide was only modestly influenced by sex, birth spacing, size of the sibling group, own socioeconomic position, own marital status, and socioeconomic rank within the sibling group. Causes of death other than suicide and other external causes were not associated with birth order.