Tuija Martelin

Why are socioeconomic mortality differences smaller among women than among men

This study examines whether womens socioeconomic mortality differences appear to be smaller than those of men because of: (1) the choice of indicator used in measuring socioeconomic position; (2) the confounding influence of other sociodemographic variables, either masking womens inequities or accentuating them among men; or (3) differences in the cause of death structure between women and men. The data set is based on individual records of the 1980 census linked with death records for the period 1981-85 in the 35-64-year old population in Finland. According to each of the socioeconomic indicators applied in this study (level of education, occupational class, housing density and standard of equipment of the dwelling) the relative magnitude of inequalities among women is considerably smaller than among men. This result arises totally from the married subpopulation--in other marital status groups womens inequalities are at least as large as mens. In most causes of death the socioeconomic mortality gradient is as steep or even steeper among women in comparison with men. When the cause of death structure of men is applied to the cause-specific mortality differences of women, the socioeconomic gradient in total mortality is almost similar among both genders even in the married population.

Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study.

Abstract Objective: To estimate the contribution of excessive alcohol use to socioeconomic variation in mortality among men and women in Finland. Design: Register based follow up study. Subjects: The population covered by the 1985 and 1990 censuses, aged ≥20 in the follow up period 1987-93. Main outcome measures: Total mortality and alcohol related mortality from all causes, from diseases, and from accidents and violence according to socioeconomic position. The excess mortality among other classes compared with upper non-manual employees and differences in life expectancy between the classes were used to measure mortality differentials. Results: Alcohol related mortality constituted 11% of all mortality among men aged ≥20 and 2% among women and was higher among manual workers than among other classes. It accounted for 14% of the excess all cause mortality among manual workers over upper non-manual employees among men and 4% among women and for 24% and 9% of the differences in life expectancy, respectively. Half of the excess mortality from accidents and violence among male manual workers and 38% among female manual workers was accounted for by alcohol related deaths, whereas in diseases the role of alcohol was modest. The contribution of alcohol related deaths to relative mortality differentials weakened with age. Conclusions: Class differentials in alcohol related mortality are an important factor in the socioeconomic mortality differentials in Finland, especially among men, among younger age groups, and in mortality from accidents and violence. Key messages Alcohol related deaths constituted 11% of all deaths in Finland among men aged 20 and above and 2% among women; the corresponding proportions were much larger for accidental and violent deaths and smaller for deaths from diseases Relative socioeconomic differentials were much larger in alcohol related mortality than in overall mortality, the largest rates being among manual workers Alcohol related mortality accounted for 14% of the mortality differentials between manual workers and upper non-manual employees among men, 4% among women, and 24% and 9% of the differentials in life expectancy, respectively The role of alcohol in the socioeconomic differentials was modest in deaths from diseases but substantial in accidental and violent deaths—for example, one half of the difference between upper non-manual employees and manual workers in accidental and violent mortality could be attributed to alcohol related deaths The impact of alcohol on relative socioeconomic mortality differentials increased with decreasing age

Mortality by indicators of socioeconomic status among the finnish elderly

Socioeconomic mortality differentials among the entire Finnish elderly population (those aged 60 years and over) during 1981-85 are examined on the basis of linked data, compiled by means of linking death records of 1981-85 to the 1980 census. Several indicators of socioeconomic position are used: own educational level and occupational class, spouses education and class, household disposable income, and housing conditions. Marked differences are found according to each of the indicators. Mortality differentials tend to decrease with age and be more pronounced among men as compared to women. In most cases differences persist even when the other socioeconomic indicators are taken into account although they diminish. The interpretation of socioeconomic mortality differentials and the problems of measuring the socioeconomic status of the elderly are discussed.

Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971–95

STUDY OBJECTIVE To quantify the contribution of different causes of death and age groups for trends in life expectancy for two major social classes. DESIGN AND SETTING Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was from the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was by computerised record linkage to death certificates for 1971–1995. MAIN RESULTS From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women respectively, with largest gains among 55–74 year old men and 65–84 year old women. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. In the 1980s, when differences in life expectancy increased most rapidly, decline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associated causes, “other diseases”, and accidents and violence were most prominent in the manual class. CONCLUSIONS Explanations of increasing social inequalities in mortality that are based on one underlying factor are difficult to reconcile with the variability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.

Differences in mortality by marital status in Finland from 1976 to 2000: Analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death

Being currently not married is more common today than 25 years ago. Over this period relative differences in mortality by marital status have increased in several countries, mainly as a result of a sharp decline in mortality among the married. Using Finnish census data linked with death certificates, we show that these increases are not explained by the non-married population becoming more marginalized in socio-economic status or household composition. However, the increases in marital-status differences in mortality from accidental, violent, and alcohol-related causes of death in the 30–64 age group indicate that changes in the health-related behaviour of the non-married population may play a role. The public-health burden associated with not being married has also grown. At the end of the 1990s about 15 per cent of all deaths above the age of 30 would not have occurred if the non-married population had had the same age-specific mortality rates as the married population.

Living arrangements and mental health in Finland.

Background: Non-married persons are known to have poor mental health compared with married persons. Health differences between marital status groups may largely arise from corresponding differences in interpersonal social bonds. However, official marital status mirrors the social reality of persons to a decreasing extent, and living arrangements may be a better measure of social bonds. Little is known about mental health in different living arrangement groups. This study aims to establish the extent and determinants of mental health differences by living arrangement in terms of psychological distress (GHQ) and DSM-IV psychiatric disorders (CIDI). Methods: Data were used from the nationally representative cross sectional health 2000 survey, conducted in 2000–1 in Finland. Altogether 4685 participants (80%) aged 30–64 years were included in these analyses; comprehensive information was available on measures of mental health and living arrangements. Living arrangements were measured as follows: married, cohabiting, living with other(s) than a partner, and living alone. Results: Compared with the married, persons living alone and those living with other(s) than a partner were approximately twice as likely to have anxiety or depressive disorders. Cohabiters did not differ from the married. In men, psychological distress was similarly associated with living arrangements. Unemployment, lack of social support, and alcohol consumption attenuated the excess psychological distress and psychiatric morbidity of persons living alone and of those living with other(s) than a partner by about 10%–50% each. Conclusions: Living arrangements are strongly associated with mental health, particularly among men. Information on living arrangements, social support, unemployment, and alcohol use may facilitate early stage recognition of poor mental health in primary health care.

Gender, Living Arrangements, and Social Circumstances as Determinants of Entry Into and Exit From Long-Term Institutional Care at Older Ages: A 6-Year Follow-Up Study of Older Finns

PURPOSE Due to population aging, the need for long-term institutional care is increasing. We study the potentially modifiable sociodemographic factors that affect the rate of entry into and exit from long-term care. DESIGN AND METHODS A 40% sample from the population registration data of Finns aged 65 and older living in private households at the end of 1997 (n = 280,722) was followed for first entry into (n = 35,926) and subsequent exit -- due to death or return to the community -- from long-term institutional care until the end of 2003. RESULTS Being female, old, living alone, and of low socioeconomic status increased the risk for entering long-term care. Exit was affected by the same factors, but the associations were weaker and, with the exception of age, in the opposite direction. Womens higher risk for entry was due to older age and greater likelihood of living alone. The effects of living arrangements and socioeconomic factors on entry were stronger among men and were attenuated after adjustment for each other and for health status. The mean duration of care was 1,064 days among women and 686 among men. IMPLICATIONS Gender, age, living arrangements, and socioeconomic status are major determinants of institutional residence. Women and certain other population groups, e.g., those living alone, are likely to spend a longer time in institutional care because of higher rates of entry and lower rates of exit. These results have implications for the financing of long-term care and for targeting of interventions aimed at delaying it.

Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus

OBJECTIVES This paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex. METHODS Five-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980. RESULTS The relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning. CONCLUSIONS Diabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons.

Social capital, health behaviours and health: a population-based associational study

BackgroundSocial capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.MethodsWe used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.ResultsSocial participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.ConclusionsIrrespective of their social status, people with higher levels of social capital – especially in terms of social participation and networks – engage in healthier behaviours and feel healthier both physically and psychologically.

Self-reported and test-based mobility limitations in a representative sample of Finns aged 30+.

Aims: The object of the present study was to acquire a comprehensive and accurate picture of mobility limitations in the Finnish adult population. Methods: A nationally representative sample of 8,028 persons aged 30+ with high participation was interviewed and examined in the Health 2000 Survey conducted in 2000—01. Mobility limitations were measured by self-reports and performance tests. Results: Perceived running difficulties were already common among persons in middle age, while difficulties in moving about indoors were frequent only among persons aged 75+. A third of women and a fifth of men aged 55+ could not reach a walking speed of 1.2 m/s. Working-aged women were more limited than men only in physically demanding tasks, but in the elderly the gender difference was evident in most mobility tasks. A substantial disagreement was found between the self-reported and test-based indicators in stair climbing. Supplementary data collection, carried out to increase participation in the health examination, as well as inclusion of institutionalized persons, provided a more complete estimate of the prevalence of mobility limitations among the elderly. Conclusions: Both self-reported and performance-based indicators are needed to achieve a comprehensive view of disability and its variation between population groups. Exclusion of institutionalized persons and low participation lead to underestimation of the occurrence of limitations. The number of persons suffering from mobility problems will increase with ageing of the population, which accentuates the importance of early intervention to maintain functional ability, especially in women.