Predictors of early retirement in British civil servants

BACKGROUND

it is uncertain how recent changes in labour force dynamics may have influenced the increasing numbers of people taking early retirement in industrialized countries. The Whitehall II study provides an opportunity to examine the predictors of early retirement in one of the largest employers in the United Kingdom.

METHODS

we examined the factors predicting early retirement in a 7-year follow-up period from 1988 to 1995 using longitudinal data on 2532 male and female London-based civil servants aged between 50 and 59.5 years. Baseline data on employment grade and duration of time working for the Civil Service were obtained from self-completed questionnaires. The primary factors examined included health, work characteristics, questions about job demands and job satisfaction and financial insecurity, wealth and material problems. Time until early retirement was analysed using Cox proportional hazards model.

RESULTS

of the 2532 civil servants, 26.7% retired early during the follow-up period. We found that men and women in the higher-paid employment grades, those that had suffered from ill health and those that were less satisfied with their jobs were more likely to retire early, whereas material problems tended to keep people working.

CONCLUSIONS

our results show that self-perceived health, employment grade and job satisfaction are all independent predictors of early retirement. Qualitative analyses may further advance our understanding of the retirement process.

The relationship between employment grade and plasma fibrinogen level among Japanese male employees. YKKJ Research Group

Plasma fibrinogen is an important risk factor for cardiovascular disease, and is associated with socioeconomic status in Europe and the United States. We evaluated whether the relationship between socioeconomic status and plasma fibrinogen level exists in Japanese male employees, and whether this relationship is independent of other correlates of plasma fibrinogen. This cross-sectional study was conducted on full-time male employees aged 20-58 in a metal-products factory between April 1996 and March 1997. Altogether 4375 employees (92.9%) participated. Low employment grade and low educational background were associated with increased age-adjusted plasma fibrinogen level. Adjusting for body mass index, waist to hip ratio, height, smoking habit, alcohol consumption, physical activity at leisure and systolic blood pressure did not attenuate these associations much. Adjusting for white blood cell count and hemoglobin Alc reduced the associations of both employment grade and educational background with plasma fibrinogen level, nevertheless these relationships remained significant.

Understanding income inequalities in health among men and women in Britain and Finland

The aims of this study were to investigate whether the relationship between income and self-perceived health is similar for men and women in two contrasting welfare states, Britain and Finland; whether the relationship between income and health is accounted for by employment status, education, and occupational social class; and whether the association differs when using alternative ways of measuring income: gross individual and net household equivalent income. Among British and Finnish men, low household and low individual income were related to poor health, even after adjusting for employment status, education, and social class. The adjusted relationship between individual income and health was stronger for British than Finnish men. Among British and Finnish women, net household equivalent income was strongly related to health, but after adjusting for employment status, education, and social class this relationship became weaker for British women and practically disappeared for Finnish women. For British women the association between income and health differed strongly depending on the income measure used; gross individual income had almost no effect on health. These results indicate that the association between health and income has no threshold in the sense that only people in poverty have poorer health than others. In further studies of income and health, household equivalent income should be used as the principal measure of income with adjustments for employment status, and men and women should be studied separately.

Diminishing educational differences in breast cancer mortality among Finnish women: a register-based 25-year follow-up

OBJECTIVES

This study examined trends in breast cancer mortality by education, age, and birth cohort.

METHODS

Census records of Finnish women 35 years and older were linked with death records for 1971 through 1995.

RESULTS

Excess breast cancer mortality of more-educated women has declined rapidly, mainly because of increasing mortality among less-educated women and stable or decreasing mortality among more-educated 35- to 64-year-old women. During the 1990s, mortality among more-educated 50- to 64-year-old women declined particularly fast.

CONCLUSIONS

The causes of declining differences by education in breast cancer mortality are difficult to verify, but they may be due in part to narrowing differences in reproductive behavior among the younger birth cohorts and to a period effect possibly associated with the introduction of breast cancer screening in the late 1980s.

Socioeconomic inequalities in mortality among women and among men: an international study

OBJECTIVES

This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia.

METHODS

National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis.

RESULTS

Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men.

CONCLUSIONS

Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.

Bias related to the exclusion of the economically inactive in studies on social class differences in mortality

BACKGROUND

To assess how the exclusion of the economically inactive affects levels and trends in social class differences in mortality among men and women at different durations of follow-up.

METHODS

Records of the 1970, 1975, 1980 and 1985 censuses on Finnish men and women aged 35-64 linked with records of all deaths during 1971-1990.

RESULTS

Exclusion of the economically inactive population underestimates the class differences in the total population by about 25% among men and 60% among women. The bias does not disappear if the first 5 years of follow-up are excluded and the bias can lead to erroneous conclusions about the trends in social class differences in mortality.

CONCLUSIONS

Analyses based on the economically active population may lead to significant underestimation of social class differences in mortality, introduce biases in international comparison and may only partially capture the causal mechanisms underlying these mortality differences. Our results further show that although the bias diminishes during the follow-up, it is by no means eliminated after the first 5 years. The underestimation of social class differences in mortality created by the exclusion of the inactive should be more widely recognized and more accurate data on previous occupations should be collected.

Determinants of socioeconomic differences in change in physical and mental functioning

Continuous decline in functioning is not an inevitable consequence of ageing, as some individuals maintain high levels of functioning to old age. The origins of functional problems in old age are not only related to current circumstances, but may be traced back to earlier life-experiences. Previous analyses show that change in functioning is related to socioeconomic status, but it is uncertain to what extent these differences can be accounted for by the same health behaviours and material and psychosocial factors that are related to socioeconomic differences in morbidity and mortality. This paper investigates socioeconomic differences in change in mental and physical functioning in a relatively young and healthy population over a three year follow-up period. The data come from the Whitehall II Study of London based civil servants aged 39-63 in 1991-93. We measured functioning with the Short Form 36 (SF-36) General Health Survey and socioeconomic status by civil service employment grade. Among lower employment grade men the odds ratio of being in the quartile of rapid decline in mental and physical functioning was 1.79 and 1.56 respectively. For women the odds ratio for physical functioning was 1.34, but employment grade differences in mental functioning were inconsistent. Among men health behaviours were the most important determinants of employment grade differences in physical functioning change. In addition, material problems and job decision latitude accounted for employment grade differences in physical as well as mental functioning change. However, among women employment grade differences in change in physical functioning can not be accounted for with these risk factors. Analyses of change in determinants may provide further insight into the underlying pathways. Early detection of functional decline and intervention may be a key to better functioning in ageing populations.

Do risk factors and health behaviours contribute to self-ratings of health?

This study examined the relative importance of five risk factors and health behaviours (namely dietary habits, leisure time exercise, smoking, alcohol consumption and body mass index) on self-ratings of health among the Swedish adult population. The data come from the 1991 Swedish Level of Living Survey, a face-to-face survey interview based on a sample representative of the Swedish population aged between 18 and 75 years (n = 5306). The analyses were carried out using logistic regression analysis. With the exception of the consumption of dietary fat, all the risk factors and health behaviours studied were associated with self-rated health. When they were adjusted for health problems and functional limitations most of the associations weakened or disappeared altogether, but smoking and use of vegetables in the diet were still associated with self-rated health. Self-ratings of young adults (18-34 years) were found to be related to body mass index even when health problems were adjusted for, with both obesity and underweight contributing to less than good self-rated health. The results indicate that risk factors and health behaviours do not, in general, directly contribute to self-ratings of health. Instead, their effect is mediated by more specific health problems and their functional consequences. However, smoking and not consuming vegetables, as well as obesity and underweight among young respondents, were found to have an independent association with self-rated health. This may reflect the effects of health problems not captured by our indicators of ill health, but may also indicate that risk factors and risky behaviours are considered to have an effect on one's perceived health even in the absence of health consequences.

Reliability of perceived health by sex and age

The aim of this study was to assess the test-retest reliability of a measure of perceived general health by sex and age. The study analyzed data from the nationally representative Mini-Finland Health Survey of 8000 adults aged 30 and over. The subjects were invited to attend a personal health interview and a health examination in 1978-1980. Altogether 7217 persons participated. Perceived general health was measured at the personal health interview and in the self-administered questionnaire 1-6 weeks apart. The identical questions were: how would you assess your current health? The response alternatives were good, fairly good, intermediate, fairly poor, poor and cannot say. This study showed that among men and women unweighted agreement of the 'good-intermediate-poor' categorization of perceived health was around 70% and unweighted kappa-values were around 0.5. Only in the oldest age-group (75+) reliability declined below these levels. The fair or good reliability of perceived health observed in this study gives additional confidence for using this general measure of overall health status in future research.

Apoptosis in situ, p53, bcl-2 and AgNOR counts as prognostic factors in laryngeal carcinoma

Apoptotic cell death, in conjunction with mitosis, plays an important role in maintaining tissue homeostasis. Many cancer treatment modalities have been shown to induce apoptosis in sensitive cells. The purpose of this study was to determine the amount of apoptosis in-situ, the expression of apoptosis related genes p53 and bcl-2 and the proliferative marker nucleolar organiser region (AgNOR), in squamous cell carcinoma (SCC) of the larynx and correlate the results to clinical outcome. Paraffin-embedded samples of 66 patients with laryngeal SCC (34 glottic, 24 supraglottic and 8 transglottic) treated at Turku University Hospital were re-examined and divided into three histological grades of differentiation, four grades of keratinisation, and four grades of p53 and bcl-2 immunostaining. The apoptosis in-situ was assessed by TUNEL and was analysed as the number of apoptosis per volume corrected high power fields. The percentages of cells containing tumour nuclei with one to more than four AgNORs were counted. The patient median age was 65, the disease-free 5-year survival was 53% and the overall survival rate was 64%. In univariate analysis, nodal status, tumour size and general condition were associated with disease-free and overall survival. In a subgroup of patients with T1-2N0 glottic cancer receiving definitive irradiation therapy (n = 25), small tumour size and good histological differentiation were associated with good disease-free and overall survival. Apoptosis associated and proliferative markers did not seem to have more value to prediction of clinical outcome than the common clinical parameters.

Occupational class and ischemic heart disease mortality in the United States and 11 European countries

OBJECTIVES

Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences.

METHODS

Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively.

RESULTS

A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years).

CONCLUSIONS

The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.

Gender differences in illhealth in Finland: patterns, magnitude and change

The common wisdom about gender differences in illhealth has been encapsulated in the phrase "women are sicker, but men die quicker". Recently this wisdom has been increasingly questioned. The purpose of this study is first to analyse the patterns and magnitude of gender differences across various indicators of illhealth; second to examine changes over time in these differences and third to assess whether sociodemographic and socioeconomic, family status and social network determinants have any bearing on the differences. The data derive from nationally representative 1986 and 1994 Surveys on Living Conditions in Finland. Women showed poorer health for five out of eight indicators analysed; that is somatic symptoms, mental symptoms, disability among those 50 years or older, long-standing illness and limiting long-standing illness were more prevalent among women than men. Male excess was found for perceived health below good and extremely limiting long-standing illness among those 50 years or older. However, the male excess was statistically significant only for poor perceived health among those 50 years or older. Adjusting for a number of suggested determinants of health had a negligible effect on gender differences. Further analyses showed that gender differences in illhealth remained largely stable over the eight year study period which saw a steep increase of unemployment for both genders. Only in the case of mental and somatic symptoms have gender differences declined, with a simultaneous increase in the prevalence of such symptoms. Otherwise gender differences in illhealth turned out to be resistant to the deep labour market crisis over this relatively short period of time. Although women had poorer health than men for a number of health indicators, we also find gender equality and even male excess for some indicators. Furthermore, the results suggest that a male excess in illhealth is likely to be found with more severe domains of illhealth among elderly people.

Socio-economic inequalities in mortality. Methodological problems illustrated with three examples from Europe

BACKGROUND

Studies from most European countries have been able to demonstrate that lower socioeconomic groups have higher risks of disease, disability and premature death. Uncertain is, however, whether these studies have also been able to estimate the precise magnitude of these inequalities, their patterns and their trends over time. The purpose of this paper is to illustrate the extent to which results of descriptive studies can be biased due to problems with the data that are commonly available to European countries.

METHODS

Three illustrations are presented from a project on socio-economic inequalities in premature morbidity and mortality in Europe. These illustrations concern three problems often encountered in data on social class differences in mortality among middle aged men: the numerator/denominator bias in cross-sectional studies (illustrated for France), the exclusion of economically inactive men (illustrated for 4 countries), and the use of approximate social class schemes (illustrated for Sweden).

RESULTS

In each illustration, inequalities in mortality among middle aged men could be demonstrated, but data problems appeared to bias estimates of the precise magnitude of inequalities in mortality, their patterns by social class and cause of death, and their trends over time. The bias was substantial in most cases. Usually, it was difficult to predict in which ways and to what extent inequality estimates would have been biased.

CONCLUSIONS

When the aim of a study is to determine the precise magnitude, patterns or time trends of health inequalities, the results should be evaluated carefully against a number of potential data problems. Investments are needed, e.g. in data sources and in the measurement of socio-economic status, to secure that future studies can describe socio-economic inequalities in health in Europe in more detail and with more reliability.

Do education and income buffer the effects of death of spouse on mortality?

In this paper, we estimate the effects of the death of a spouse on the mortality of the survivor in different education and income groups. These socioeconomic resources may buffer the harmful effects of the stressful life event of the loss of one's spouse. The data come from a prospective study of mortality among all 35- to 74-year-old married Finnish persons. Follow-up was established by record linkage to death certificate registers for 1986-1991 (about 86,000 deaths, of which almost 5,500 occurred among the bereaved). The relative mortality after the death of one's spouse was broadly similar in different education and income groups. Absolute differences in mortality rates between bereaved and nonbereaved persons were larger in the lower end of the social spectrum, however. This pattern held for four broad categories of death: both sexes and two age groups (35-64 years and 65-74 years). The degree to which socioeconomic resources buffer the effects of death of spouse depends on whether it is assessed in terms of rate differences or rate ratios. Nevertheless, regardless of measurement choice, the effects of bereavement exist in all socioeconomic groups analyzed in this study. Furthermore, because of the high absolute level of mortality, the burden of excess mortality experienced after the death of one's spouse is heavier in the lower social strata.

Examining the continuity of self-rated health

BACKGROUND

The study examines whether self-rated health forms a continuum from poor through average to good health in terms of two groups of health-related variables.

METHODS

The data come from the 1994 Finnish Survey on Living Conditions, a representative sample of Finnish men and women aged 25 years or older (n = 7290). Logistic regression analysis was used with two dependent variables: (1) average versus good/excellent self-rated health and (2) poor versus good/excellent self-rated health. Two groups of independent variables were used: (1) risk factors and (2) ill-health indicators. Separate analyses were made for men and women controlling for sociodemographic background variables.

RESULTS

Of the risk factors, BMI and physical exercise were associated both with average and poor self-rated health whereas frequency of drinking was only associated with poor health. All used indicators of ill health were strongly associated with average as well as poor self-rated health. With the exception of BMI, the associations of both risk factors and ill health were stronger with poor than with average health.

CONCLUSIONS

The study suggests that self-rated health forms a continuum from poor to good health when risk factors and indicators of ill health are considered, and that there are only minor differences in the continuity of self-rated health between men and women.

Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort

OBJECTIVES

This study examines excess mortality among Finnish persons after the death of a spouse, by sex, the subject's cause of death, duration of bereavement, and age.

METHODS

The subjects were 1580000 married Finnish persons aged 35 through 84 years who were followed up from 1986 through 1991.

RESULTS

Excess mortality among the bereaved was high from accidental, violent, and alcohol-related causes (50% to 150%), moderate for chronic ischemic heart disease and lung cancer (20% to 35%), and small for other causes (5% to 15%). Excess mortality was greater at short ( < 6 months) rather than long durations of bereavement and among younger rather than older bereaved persons for most causes of death; it was also greater among men that women.

CONCLUSIONS

The results are consistent with the hypothesis that excess mortality after the death of a spouse is partly caused by stress. The loss of social support or the inability to cope with stress may explain why men suffer from bereavement more than do women.

Mortality after death of spouse in relation to duration of bereavement in Finland

STUDY OBJECTIVES

(1) To assess the extent to which death of a spouse causes excess mortality by controlling for the effects of confounding and other sources of bias. Three possible sources of bias are considered: accidents common to spouses, common socioeconomic environment, and common lifestyles. (2) To assess the duration specific effects of death of a spouse on mortality.

DESIGN AND SETTING

Prospective study of mortality in Finland among all 35-84 year old married Finnish men and women (1,580,000 people). Baseline sociodemographic measurement from the 1985 census records. Follow up by computerised record linkage to death certificate registers for the period 1986-91 (about 116,000 deaths, of which almost 10,000 among the bereaved) using personal identification codes.

RESULTS

(1) After controlling for confounding effects, excess mortality was 17% in men and 6% in women. (2) Excess mortality was higher for short durations than long durations of bereavement. (3) Excess mortality after bereavement was higher in men than women.

CONCLUSIONS

Controlling for confounding does not seem to have a crucial modifying effect on the relationship between spousal bereavement and mortality. It seems that death of a spouse has a causal effect on mortality. However, although spousal bereavement is a major stressful life event, this causal effect seems to be relatively small and short lived.

Paclitaxel-induced apoptotic changes followed by time-lapse video microscopy in cell lines established from head and neck cancer

Paclitaxel (Taxol) is a potent chemotherapeutic drug for squamous-cell carcinoma (SCC) of the head and neck in vitro with microtubule-stabilizing activity that arrests cells in G2-M. To study the mechanism of its cytotoxic effect on SCC in vitro, we exposed five laryngeal SCC cell lines to 10 nM paclitaxel. The cell lines were studies by time-lapse video microscopy for 96 h, and by agarose gel electrophoresis. Paclitaxel blocked the cells in the premitotic phase for 6-24 h, after which the cells died morphologically by apoptosis. Mitotically arrested cells were seen within a few minutes after exposure to paclitaxel. No mitoses were seen in the paclitaxel-treated cells. A few apoptoses were also seen in the control cultures grown without paclitaxel, but they represented only 6%-20% of the frequency of apoptoses seen in the paclitaxel-treated group. In some paclitaxel-treated cultures the cells escaped the mitotic arrest without cytokinesis and formed multinucleated cells that eventually died. Agarose gel electrophoresis showed oligonucleosomal DNA fragmentation characteristic of apoptosis. We conclude that time-lapse video microscopy is an efficient method of observing drug-induced morphological changes in cell culture. Paclitaxel at a 10 nM concentration rapidly induces a premitotic block, which usually leads to apoptotic cell death. In some cases multinucleated cells are formed that morphologically also eventually die by apoptosis.

Experimental research on the morphofunctional differentiation of the rat ventral prostate: roles of the gonads at birth

In the male rat, a dramatic increase in serum testosterone (T) of testicular origin occurs during the first few hours of postnatal life. This experiment sought to determine whether this increase affects the physiology of the adult rat ventral prostate. Male rats were castrated at the time of caesarean delivery performed at different precise stages between 21 days and 22 days of gestation (0h males). Newborn male rats were castrated after spontaneous delivery at 22 days of gestation at 6, 12, 24 or 48 h after birth. Some male rats were castrated at fetal stage 21 days 13-15 h and injected at the time of surgery with 1, 2.5 or 5 micrograms of testosterone propionate (TP). Control males were sham operated at fetal stage 21 days 13-15 h and castrated at 23 days postnatal. At 30 days of age, each male was given T replacement therapy through a T filled silastic capsule until the time of sacrifice at 100 days of age. Before T implantation at 30 days of age, castration at 0 h or 48 h after birth does not impair neither branching morphogenesis nor the organization of the prostatic acinus. In contrast, the histological structure of the ventral prostate of the 0 h males implanted with T from puberty on is greatly disturbed. Cribriform and severe atypic hyperplastic acini with various epithelial cell arrangements are common. The alveolar sheath of the prostatic glands and the interacinar stroma are enlarged. In acini with severe intraepithelial hyperplasia, the disorganized epithelium rests over a thick basement membrane that stains strongly for laminin. In some 0 h males, epithelial cells break through the periacinar fibromuscular sheath and invade the interacinar stroma. It is as though all the categories of cells comprising the ventral prostate were not programmed in the absence of neonatal androgens. The secretory activity and the expression of Prostate Binding Protein (PBP) are impaired in the ventral prostate of the 0 h males. Castration performed after 12 h after birth has no deleterious effect on either secretory activity or PBP expression. The critical period during which perinatal T affects the histological structure and the functional differentiation of the ventral prostate extends from fetal stage 21 days up to 1 or 2 days postnatal. A single injection of 2.5 micrograms TP, a dose which mimicks the postpartum T surge is sufficient for programming the histological structure and the functional differentiation of the adult ventral prostate.

Women's employment, marriage, motherhood and mortality: a test of the multiple role and role accumulation hypotheses

Two contrasting hypotheses on the effects of combining marital, parental and work roles on mortality are analysed in this paper. The 'multiple role' hypothesis suggests that the effects are harmful, but the 'role accumulation' hypothesis argues that the benefits will outweigh the possible harmful effects. This paper uses record linkage data for all 35-64 year-old non-pensioned Finnish women to examine the two hypotheses. Women with all three roles of wife, mother and employee had low mortality. This, however, was a reflection of the main effects of these three variables. Only lone mothers with > 1 child--about 4% of the study population--were characterized as having a somewhat deviant mortality from what was to be expected on the basis of the main effects model. The high mortality in this group was mainly due to causes of death related to accidents and violence and circulatory diseases. Further analysis indicated that the excess mortality among lone mothers with two or more children and the lack of interactions for any other role constellation was similar in all age and educational groups. It is concluded that neither of the hypotheses on multiple roles are very relevant for the analysis of female mortality and that more attention should be devoted to understanding the contribution of possible selection effects leading to marriage and motherhood and the contribution of the 'healthy worker effect' in creating low mortality for the employed.

Isolation of potentially pathogenic mycobacteria in the Finnish environment

Atypical mycobacteria have become more common in clinical samples, and their reservoirs, known to be in the environment, are poorly identified. In the Finnish natural environment, mycobacteria can be cultivated from surface waters in a mean of 1500 CFU/l and from soil samples in a mean of 3.6 x 10(5) CFU/g dry weight. The majority of isolates are not pathogenic to man. Less than 10% of cultivable mycobacteria belong in species which are also found in human samples, either as infectious agents or as harmless colonizers of human epithelia. The two most important potentially pathogenic atypical mycobacteria in Finland, the Mycobacterium avium-intracellulare-scrofulaceum (MAIS) complex and M. malmoense, were detected in 40% and 4%, respectively, of the examined waters.