A comparison of socioeconomic differences in physical functioning and perceived health among male and female employees in Britain, Finland and Japan

We compared the pattern of socioeconomic inequalities in physical functioning and perceived health among male and female employees in Britain, Finland and Japan. Participants were male and female public sector employees in Britain, Finland and Japan, who were economically active and 40-60 year-olds at the time of data collection. We measured perceived health and physical functioning (SF-36 physical component summary) with standardized health questionnaires. The results obtained here reconfirm the similarity of the patterns of ill-health of those with lower socioeconomic status among non-manual men and women in Britain and Finland. These data also provide good evidence for a socioeconomic gradient in ill-health among Japanese non-manual men, although this gradient was less systematic. For Japanese men poorer health of manual workers as compared to non-manual workers was well demonstrated. However, among Japanese women socioeconomic differences in health were small and inconsistent. In conclusion, Britain, Finland and Japan--representing 'liberal', 'Nordic' and 'conservative' welfare state regimes--produce broadly similar patterns of socioeconomic differences in health among men. However, different patterns of labour force participation and welfare provision in different welfare regimes may bring about different patterns of socioeconomic differences in health for working women. This is exemplified by the lack of health inequalities among employed Japanese women.

Effect of environmental and genetic factors on education-associated disparities in weight and weight gain: a study of Finnish adult twins

BACKGROUND

Disparities in body mass index (BMI) between persons with different educational levels in Western countries are well documented, but the background of these education-associated disparities remains poorly understood.

OBJECTIVE

The objective was to examine the influence of environmental and genetic factors on education-associated disparities in self-reported BMI and weight change.

DESIGN

Longitudinal postal surveys were performed in 1975, 1981, and 1990. The data were analyzed by using multivariate genetic models for twin data. The data derived from the Finnish Twin Cohort included 2482 monozygotic and 5113 dizygotic same-sex male and female twin pairs born between 1915 and 1957.

RESULTS

Education-associated differences in BMI and in weight change were clear in 1975 and 1981, respectively, whereas no differences were seen in weight change between 1981 and 1990 when age and baseline BMI were adjusted for. The trait correlation between baseline BMI and educational attainment (-0.15 in men and women) was mainly due to correlations between additive genetic factors that contributed to BMI and education in men (-0.20; 95% CI: -0.25, -0.14) and women (-0.32; 95% CI: -0.40, -0.25) when adjusted for age. Among women, a weaker positive correlation was found for the unshared environmental effects contributing to the 2 traits (0.06; 95% CI: 0.02, 0.12). The same factors that affected the association between education and BMI in 1975 largely explained the association between education and weight change in 1981.

CONCLUSION

The results suggest the possibility that common genetic factors affect educational attainment and body weight, which contribute to education-associated disparities in BMI in adulthood.

Pathways between socioeconomic determinants of health

STUDY OBJECTIVE

Many previous studies on socioeconomic inequalities in health have neglected the causal interdependencies between different socioeconomic indicators. This study examines the pathways between three socioeconomic determinants of ill health.

DESIGN, SETTING, AND PARTICIPANTS

Cross sectional survey data from the Helsinki health study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55, and 60 years received a mailed questionnaire. Altogether 6243 employees responded (80% women, response rate 68%). Socioeconomic indicators were education, occupational class, and household income. Health indicators were limiting longstanding illness and self rated health. Inequality indices were calculated based on logistic regression analysis.

MAIN RESULTS

Each socioeconomic indicator showed a clear gradient with health. Among women half of inequalities in limiting longstanding illness by education were mediated through occupational class and household income. Inequalities by occupational class were largely explained by education. A small part of inequalities for income were explained by education and occupational class. For self rated health the pathways were broadly similar. Among men most of the inequalities in limiting longstanding illness by education were mediated through occupational class and income. Part of occupational class inequalities were explained by education. Two thirds of inequalities by income were explained by education and occupational class.

CONCLUSIONS

Parts of the effects of each socioeconomic indicator on health are either explained by or mediated through other socioeconomic indicators. Analyses of the predictive power of socioeconomic indicators on health run the risk of being fruitless, if interrelations between various indicators are neglected.

Smoking cessation by socioeconomic status and marital status: The contribution of smoking behavior and family background

We studied socioeconomic status and marital status as predictors of smoking cessation, adjusting for previous smoking behavior and family background by using a large Finnish prospective twin dataset unselected for smoking behavior. The data were collected by postal surveys in 1981 and 1990, and the sample comprised 3,069 current smokers, of whom 20% had quit smoking by 1990. Logistic regression analyses of all twin individuals and conditional logistic regression analysis of discordant pairs were used to predict smoking cessation. High education predicted smoking cessation among both men (OR=2.32, 95% CI=1.31-4.10) and women (OR=3.98, 95% CI=1.85-8.51) as did high social class among women. Additionally, starting at a late age, smoking a small number of cigarettes per day, and a low level of nicotine per cigarette predicted cessation. Socioeconomic differences in cessation diminished only slightly when we adjusted for smoking behavior factors. Among the twin pairs who were discordant in terms of smoking cessation, the twin who continued smoking also smoked more on average at baseline (men: OR=.94, 95% CI=.89-.99; women: OR=.82, 95% CI=.71-.94). The male twins who continued smoking had a smaller probability of getting married during the follow-up than had the cotwin who had quit smoking (OR=3.91, 95% CI=1.02-15.02). Indicators of socioeconomic status were important predictors of smoking cessation even when we adjusted for previous smoking behavior. For men, marriage was associated with an increased probability of cessation

Does conflict between home and work explain the effect of multiple roles on mental health? A comparative study of Finland, Japan, and the UK

BACKGROUND

Although there have been a number of studies on the effects of multiple roles on health and how a combination of work and family roles may be either advantageous (role enhancement) or disadvantageous (role strain) for health, there has been relatively little investigation on the psychosocial content of such roles. Work-to-family conflict and family-to-work conflict could arise from inability to combine multiple roles and result in stress and ill health. The question of whether both types of conflict mediate between the association of multiple roles with health has not been analysed before. This paper sets out to investigate whether: (1) work-to-family conflict or family-to-work conflict contributes towards explaining the association of multiple roles with mental health; (2) the effect of work-to-family conflict and family-to-work conflict on mental health varies by gender; (3) the effect of work-to-family and family-to-work conflict on mental health vary between countries with different welfare state arrangements and social norms.

METHODS

Cross-sectional data of economically active male and female public sector employees aged 35-60 in London (UK), Helsinki (Finland), and the West Coast of Japan. Linear regression models (separate for each gender and cohort) of SF-36 mental component scores were analysed with role combinations, family-to-work and work-to-family conflict as explanatory variables.

RESULTS

Single fathers in all three cohorts and of single mothers in the Helsinki cohort had poor mental health, and this was partly explained by their higher levels family-to-work conflict. Both types of conflict affect the mental health of men and women independently of each other. Japanese women had the greatest conflict and poorest mental health while Helsinki women had the lowest conflict and best mental health.

CONCLUSION

Both work-to-family and family-to-work conflict affect the mental health of men and women in three different countries. Work and family roles and the balance between the two may be important for the mental health of men and women in industrialized societies. Any analysis of the effect of multiple roles on health needs to take into account the psychosocial content of such roles.

Mental health and food habits among employed women and men

The aim of this study was to examine the association between mental health and recommended food habits among employed middle-aged women and men. A mail survey including data on mental health and intake of food items was collected from 40 to 60-year-old women (n=4991) and men (n=1252) employed by the City of Helsinki. The participants' current mental health status was assessed by the General Health Questionnaire 12-item version and categorised into 'poor' (score 3-12) and 'normal' mental health (score 0-2). Multivariable logistic regression analyses were conducted using this categorisation as an independent variable to predict recommended food habits among women and men. All analyses first adjusted for age and lifetime mental diagnosis, secondly socio-economic status variables, and thirdly health behaviours. Women having poor mental health were less likely than their healthier counterparts to report consuming fresh vegetables, fresh fruits, low-fat milk and low-fat cheese on a daily basis, and cereals or porridge at least five times a week. Men having poor mental health reported consuming less frequently fresh fruits and dark bread. Except for cereals and dark bread, these results remained statistically significant in the fully adjusted model. The results suggest that poor mental health is associated with unhealthy food habits.

Relative weight and income at different levels of socioeconomic status

OBJECTIVES

We examined the association of relative weight with individual income at different levels of socioeconomic status among gainfully employed Finnish women and men.

METHODS

We used a population-based survey including 2068 women and 2314 men with linked income data from a taxation register. Regression analysis was used to calculate mean income levels within educational and occupational groups.

RESULTS

Compared with their normal-weight counterparts, obese women with higher education or in upper white-collar positions had significantly lower income; a smaller income disadvantage was seen in overweight women with secondary education and in manual workers. Excess body weight was not associated with income disadvantages in men.

CONCLUSIONS

Obesity is associated with a clear income disadvantage, particularly among women with higher socioeconomic status.

Working conditions and health behaviours among employed women and men: the Helsinki Health Study

BACKGROUND

Working conditions influence health, but previous studies on the associations between work-related factors and health behaviours are scarce. The aim of this study was to analyse whether unfavourable working conditions are associated with diet, physical activity, alcohol consumption, and smoking.

METHODS

The data derive from postal questionnaires collected in 2000-2001 from 40- to 60-year-old employees of the City of Helsinki (n=6243, response rate: 68%). Logistic regression analysis was used to examine health behaviours as outcomes. Job demands and job control, physically and mentally strenuous work, work fatigue, working overtime and satisfaction with work-home interface were independent variables, adjusted for age, education, occupational social class and marital status.

RESULTS

Most of the examined associations between working conditions and health behaviours were not statistically significant. Among women, mentally strenuous work and high job control were associated with a healthy diet. Work fatigue was associated with physical inactivity, whereas physically strenuous work and satisfaction with work-home interface were more often reported by physically active women. Work fatigue was associated with high drinking among men. Low job strain was reported by nonsmoking women, whereas working overtime was associated with nonsmoking among men.

CONCLUSIONS

Working conditions were only weakly associated with health behaviours, and the associations varied for different health behaviours.

Income and health behaviours. Evidence from monitoring surveys among Finnish adults

STUDY OBJECTIVE

To examine the associations of individual and household income with various health behaviours, before and after adjusting for educational attainment and occupational social class.

DESIGN AND SETTING

Data from 19 982 respondents to nationwide health behaviour surveys from 1993 to 1999 (response rate 70%) were linked with socioeconomic information from population registers.

MEASUREMENTS

The income measures were total individual income liable to taxation and household's monthly disposable income. Health behaviours included smoking, alcohol use, leisure time physical activity, use of vegetables, use of saturated fat on bread, and being overweight.

MAIN RESULTS

In men, smoking and infrequent vegetable use were more common among those with lower individual and household income. However, adjusting for education and occupational class removed most of the differences. Use of saturated fat on bread increased with decreasing individual income, before and after the adjustments. In women, smoking, infrequent vegetable use and being overweight were more common among those with lower income, but the differences by both income measures were largely removed by the adjustments. Women with higher income more often also were high alcohol users and had less physical activity, in particular when income was measured by the respondents' individual income.

CONCLUSIONS

Adjusting for education and occupation largely removed income differences in health behaviours, but for some behaviours some independent effect remained. The results suggest that income does not only reflect the available material resources, but works as a general socioeconomic indicator that is associated with health behaviours in much the same way as other socioeconomic indicators.

Assortative mating by body height and BMI: Finnish twins and their spouses

Assortative mating by body height and weight is well established in various populations, but its causal mechanisms remain poorly understood. We analyzed the effect of phenotypic assortment and social homogamy on spousal correlations for body height and body mass index (BMI, kg/m(2)). Our data derived from a questionnaire administered to the adult Finnish Twin Cohort in 1990 (response rate 77%) yielding results from 922 monozygotic and 1697 dizygotic adult twin pairs who reported information about their body height and weight and that of their spouses. Assortative mating was evident for body height and BMI. For body height, the effects of social homogamy (0.24 in men and 0.29 in women) and phenotypic assortment (0.27 and 0.28, respectively) were about the same. For BMI, the effect of social homogamy was stronger (0.31 in men and 0.28 in women) than the effect of phenotypic assortment (0.13 in both men and women). When assortative mating was taken into account, shared environmental factors had no effect on phenotypic variation in body height or BMI. Our results show that assortative mating needs to be considered in population genetic studies of body height and weight.

Work conditions and socioeconomic inequalities in work ability

OBJECTIVES

The objective of this study was to investigate socioeconomic inequalities in work ability among municipal employees and the contribution of work conditions to these inequalities.

METHODS

The subjects were employees of the City of Helsinki and were all over 40 years of age. Data (N=1,827) were collected in the age-group-based medical check-ups by occupational health personnel. Work ability was measured with a work ability index. The association between the work ability index with socioeconomic status was examined by fitting logistic regression models.

RESULTS

There was a consistent gradient in work ability, lower socioeconomic groups having poorer work ability. Adjusting for physical stress accounted for a substantial part of the socioeconomic inequalities. Adjusting for possibilities for influence and development at work accounted for some of the difference between white-collar and blue-collar employees, but not for differences between the white-collar subgroups among the women. Mental stress and problems in the social environment were not clearly associated with the inequalities.

CONCLUSIONS

Socioeconomic inequalities in work ability among municipal employees correspond to the inequalities in ill health found in general populations. Physical stress at work explained a large part of the inequality. Poor possibilities to influence one's work contributed to the excess of lowered work ability among the blue-collar employees, but not to the inequalities between white-collar subgroups of women. Apart from physical workload, work conditions did not explain socioeconomic inequalities between white-collar subgroups of women.

Associations among health-related behaviours: sociodemographic variation in Finland

OBJECTIVES

The study examines sociodemographic variation in associations and co-occurrence of health behaviours that contribute to multifactorial chronic diseases.

METHODS

Mantel-Haenszel odds ratios were used to examine pairwise associations among smoking, alcohol use, physical activity, and diet across categories of sociodemographic characteristics. Breslow-Day test for homogeneity was used to test for sociodemographic differences. In addition, co-occurrence of each two unhealthy behaviours was examined across sociodemographic groups using nationwide population survey data from 26,014 Finnish adults.

RESULTS

Most of the health behaviours examined were interrelated and sociodemographic differences in the associations were few. Differences were inconsistent for all sociodemographic characteristics. Variation was observed only in the strength of the associations, not in their direction. However, due to unequal distribution of the individual behaviours, co-occurrence of unhealthy behaviours varied strongly across sociodemographic groups.

CONCLUSIONS

Associations between health behaviours were relatively similar across sociodemographic groups. Since co-occurrence of unhealthy behaviours depends on the prevalence of individual unhealthy behaviours and the strength of their association, their co-occurrence in any particular sociodemographic group was primarily determined by the prevalence of individual unhealthy behaviours.

The association between body height and coronary heart disease among Finnish twins and singletons

OBJECTIVE

An inverse association between body height and the incidence of coronary heart disease (CHD) has been observed. However, the mechanisms behind this association are still largely unknown. We will examine the role of genetic and familial factors behind the association in a large twin data set.

DESIGN AND SETTING

The data were derived from the Finnish Twin cohort including 2438 singletons, 4073 monozygotic (MZ) twins, and 9202 dizygotic (DZ) twins aged 25-69 years at baseline in 1976. Incident CHD cases were derived from hospital discharge data and cause of death data between 1977 and 1995. Cox regression analysis and conditional logistic regression analysis were used.

RESULTS

In population-level analyses no differences in the general risk of CHD between zygosity groups were found. The association between body height and CHD was similar between sexes and zygosity groups. When men and women in all zygosity groups were studied together an increased risk of CHD was found only among the shortest quartile (hazard ratio [HR] = 1.34, 95% CI: 1.14-1.57). Among the twin pairs discordant for CHD a suggestive increased risk for the shorter twin was seen among DZ twins (odds ratio [OR] = 1.19, 95% CI: 0.95-1.48) when men and women were studied together.

CONCLUSION

An inverse association between body height and CHD was broadly similar between sexes and twin zygosity groups and was associated with short stature. Among discordant twin pairs we found a weak association among DZ twins but not MZ twins. This may suggest the role of genetic liability behind the association between body height and CHD.

Analysing changes of health inequalities in the Nordic welfare states

This study examined changes over time in relative health inequalities among men and women in four Nordic countries, Denmark, Finland, Norway and Sweden. A serious economic recession burst out in the early 1990s particularly in Finland and Sweden. We ask whether this adverse social structural'development influenced health inequalities by employment status and educational attainment, i.e. whether the trends in health inequalities were similar or dissimilar between the Nordic countries. The data derived from comparable interview surveys carried out in 1986/87 and 1994/95 in the four countries. Limiting long-standing illness and perceived health were analysed by age, gender, employment status and educational attainment. First, age-adjusted overall prevalence percentages were calculated. Second, changes in the magnitude of relative health inequalities were studied using logistic regression analysis. Within each country the prevalence of ill-health remained at a similar level, with Finns having the poorest health. Analysing all countries together health inequalities by employment status and education showed no major changes. There were slightly different tendencies among men and women in inequalities by both health indicators, although these did not reach statistical significance. Among men there was a suggestion of narrowing health inequalities, whereas among women such a suggestion could not be discerned. Looking at particular countries some small changes in men's as well as women's health inequalities could be found. Over a period of deep economic recession and a large increase in unemployment, particularly in Finland and Sweden, health inequalities by employment status and education remained broadly unchanged in all Nordic countries. Thus, during this fairly short period health inequalities in these countries were not strongly influenced by changes in other structural inequalities, in particular labour market inequalities. Institutional arrangements in the Nordic welfare states, including social benefits and services, were cut during the recession but nevertheless broadly remained, and are likely to have buffered against the structural pressures towards widening health inequalities.

Health inequalities by education and age in four Nordic countries, 1986 and 1994

STUDY OBJECTIVE

To compare the age pattern of educational health inequalities in four Nordic countries in the mid-1980s and the mid-1990s.

DESIGN

Cross sectional interview surveys at two points of time.

SETTING

Data on self reported limiting longstanding illness, and perceived health were collected from Denmark, Finland, Norway, and Sweden in 1986/87 and in 1994/95.

PARTICIPANTS

Representative samples of the non-institutionalised population at 15 years or older. Analyses were restricted to respondents aged between 25 and 75 (n= 23 325 men and 24 184 women). Response rates varied from 73% to 87%.

MAIN RESULTS

The age adjusted prevalence of limiting longstanding illness in Finland was 10% higher in men and 6% higher in women than in other Nordic countries in 1986/87 but the gap narrowed by 1994/95. Educational health inequalities were largest in Norway. In 1986/87 the odds ratio (OR) for limiting longstanding illness was 11.25 (95% CI 8.66 to 14.62) among men and 8.23 (95% CI 6.60 to 10.27) among women in the oldest age group (65-74 years old) in Finland when the youngest age group (25-34 years old) was used as the reference category (OR=1.00). The age pattern in Finland was steeper than in Sweden (OR=5.02, 95% CI 3.97 to 6.34 in men and 5.29, 95% CI 4.18 to 6.71 in women) or Norway (OR=6.32, 95% CI 4.06 to 9.84 and 5.45, 95% CI 3.81 to 7.82, respectively). In 1994/95 relative health improved in the oldest age group in Finland (OR=5.80, 95% CI 4.33 to 7.78 in men and 5.94, 95% CI 4.52 to 7.79 in women) and in Norway (OR=4.55, 95% CI 3.01 to 6.88 and 3.96, 95% CI 2.70 to 5.81, respectively) but remained stable in Sweden. The study compared health differences by age in different educational categories and found that in Finland in 1986/87 the health in the oldest age group was poorer for secondary (OR=10.59, 95% CI 5.96 to 18.82) or basic educated (OR=9.76, 95% CI 6.66 to 14.30) men than for men with higher education (OR=5.15, 95% CI 2.59 to 10.22). The difference was not found among women or in other Nordic countries and it diminished among men in Finland in 1994/95. The results of perceived health were broadly similar to the above results of limiting longstanding illness.

CONCLUSION

The results suggest that compared with other Nordic countries the comparatively poorer health in Finland is partly attributable to a cohort effect. This may be associated with the lower standard of living in Finland that lasted until the mid-1950s. The cohort effect is also likely to contribute to educational health inequalities among older Finnish men. The results suggest that not only current social policies but also past economic circumstances are likely to affect the overall health status as well as health inequalities.

Multiple roles and health among British and Finnish women: the influence of socioeconomic circumstances

Two contrasting hypotheses have been presented to predict women's health variations. The Multiple burden hypothesis predicts that combining a paid job, being married, and having children is likely to be detrimental to women's health. The multiple attachment hypothesis predicts that multiple roles provide attachment to the community, which is likely to be beneficial to women's health. These hypotheses are examined in Britain and Finland, which have different patterns of women's employment participation. Lone mothers form a critical case, since they have fewer attachments and greater burdens, and therefore are expected to have poorer health. The socioeconomic position of lone mothers differs in Britain and Finland, but in both societies they are likely to have fewer attachments. We assess the extent to which health variations between women with different family and parental role combinations are because of the differences in their socioeconomic status and material circumstances. Comparable surveys from Britain and Finland from 1994 were used. Perceived general health and limiting long-standing illness were analysed for working age women (20-49 years) by family type and employment status. as well as other socioeconomic variables. In both countries, women living in two parent families and having children had better health than women living in other family types or on their own. Lone mothers form a disadvantaged group and showed overall worse health in both countries. Adjusting for employment status. education and household income weakened the association between family type and poor health. The findings are broadly in accordance with the multiple attachment hypothesis. Despite the more generous welfare state and high full-time employment among Finnish women, single lone mothers report poorer health than other women in Finland as well as in Britain. However, in Britain the disadvantaged social position of lone mothers accounts for a greater proportion of their poor health than in Finland.

Determinants of attempted suicide in urban environment

This paper investigates, first, the differences in attempted-suicide rates among men and women between urban districts and, second, the association between regional characteristics and attempted-suicide rates. The data cover all attempted suicides referred to healthcare in 1989 and 1997 in Helsinki, Finland. There are clear and persistent differences in the attempted-suicide rates between the studied districts. Although female rates increased in all seven districts from 1989 to 1997, their mutual relationships remain similar. There are more changes among men both within and between the districts. Socio-economic disadvantage within the districts was associated with higher attempted-suicide rates. We conclude that socio-economic characteristics and their changes over time in the districts are likely to affect the suicidal behaviour of men more than women. Improving the employment status and structural position, especially of men, would probably prove to be important for the prevention of attempted suicide.

Structural changes and social inequalities in health in Finland, 1986-1994

BACKGROUND

This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups.

METHODS

The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25-64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses.

RESULTS

The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes.

CONCLUSIONS

Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.

Changing health inequalities in the Nordic countries?

The Nordic countries, referring here to Denmark, Finland, Norway, and Sweden, have often been viewed as a group of countries with many features in common, such as geographical location, history, culture, religion, language, and economic and political structures. It has also been habitual to refer to a "Nordic model" of welfare states comprising a large public sector, active labour market policies, high costs for social welfare as well as high taxes, and a general commitment to social equality. Recent research suggests that much of this "Nordicness" appears to remain despite the fact that the Nordic countries have experienced quite different changes during the 1980s and 1990s. How this relates to changes in health inequalities is in the focus of this supplement.

Food insecurity is associated with past and present economic disadvantage and body mass index

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

Educational differences in lung cancer mortality in male smokers

BACKGROUND

To assess the extent of lung cancer mortality differentials by education while adjusting for exposure to tobacco smoke and asbestos based on survey questions.

METHODS

Alpha-Tocopherol, Beta Carotene Cancer Prevention (ATBC) Study of 50-69-year-old Finnish male smokers enrolled 1985-1988. These analyses are based on the placebo group and the alpha-tocopherol supplementation group, altogether 14 011 men, with full information on tobacco smoking. Mortality follow-up was to the end of April 1993 and it was based on the complete death certificate register of the Statistics Finland.

RESULTS

Lung cancer mortality of basic-educated men was 32% (rate ratio [RR] = 1.32; 95% CI : 0.93-1.87) higher than that of better-educated men in the ATBC Study. The excess is practically unchanged when additional adjustment was made for age at initiation, duration of smoking, current smoking at baseline and at first follow-up, smoke inhalation, occupational exposure to asbestos and interactions between asbestos exposure and all smoking variables. This excess mortality was about 40% of the similar excess observed in the general population of men of similar age.

CONCLUSIONS

Educational differences in lung cancer mortality in the total Finnish population are likely to be mainly caused by differences in exposure, particularly to active smoking. Further understanding of the determinants and consequences of socioeconomic differences in smoking behaviour are of major scientific and public health importance.

Transitions of employment status among suicide attempters during a severe economic recession

Previous studies have shown a positive association between unemployment and attempted suicide. This study investigated transitions of employment status among suicide attempters during the severe economic recession. The main research question was whether inequality in the labour market also prevails among as selected a population as suicide attempters. The material consisted of 2495 persons who attempted suicide during 1989-1994 in Helsinki, Finland. Logistic regression analysis and survival analysis were used. Unemployment rates among suicide attempters were higher than in the general population, male rates being higher than female rates throughout the recession. There were significant changes in the employment status of the entire attempted suicide population from 1989 to 1994, especially in terms of the transition from employment to unemployment. Gender, age and education level predicted exit from the labour market. Among suicide attempters young middle-aged men with low education had the highest risk of unemployment.

Body height, birth cohort and social background in Finland and Sweden

BACKGROUND

Poor childhood living conditions are associated with short stature. Before the Second World War Finland had much lower living standards than Sweden, but this gap had largely disappeared by the 1970s. Body height differences were examined by birth cohort, economic difficulties in childhood and adult socioeconomic position in Finland and Sweden.

METHODS

Two nationally representative data sets were used (n = 7,300 in Finland and n = 4,551 in Sweden). Three indicators of social background were included, i.e. economic difficulties in childhood, education and occupational class. The methods used were direct age-standardisation, index of dissimilarity and regression analysis.

RESULTS

In the cohort born in 1920-1929 body height was taller in Sweden (175.8 cm among men and 163.7 cm among women) than in Finland (173.9 and 161.2 cm respectively). Body height by birth cohort increased faster in Finland, with the result that, in the cohort born in 1960-1969, the gap between the countries had narrowed to 0.8 cm among men and 0.3 cm among women. Body height differences by social background were larger in Finland than in Sweden. Socioeconomic body height differences have remained largely stable over the birth cohorts in both countries.

CONCLUSIONS

The results suggest that differential economic development is partly seen in the narrowing of body height differences between Finland and Sweden. However, socioeconomic differences in body height have remained largely similar over the birth cohorts studied and between Finland and Sweden.

[Small changes in health differences in the Nordic countries during the 1980s and 1990s]

The study examined changes over time in health inequality in Denmark, Finland, Norway and Sweden. Data derive from comparable interview surveys carried out in 1986/87 and 1994/95. Limiting long-standing illness and perceived ill health were analysed regarding age, gender; educational attainment, and employment status. Age adjusted prevalence rates were calculated. Changes in differences in health were found in education and employment status groups. There was little or no change in the prevalence of ill health during the time period studied. Despite social and economic changes differences in health remained broadly stable in the examined countries.

Self rated health and mortality: a long term prospective study in eastern Finland

STUDY OBJECTIVE

To assess the relation between self rated health and mortality over a period of 23 years, taking into account medical history, cardiovascular risk factors, and education at the beginning of the follow up.

DESIGN

A cohort of random population samples. The baseline studies included a self administered questionnaire and a health examination. Mortality data were collected from the national mortality register using personal identification numbers.

SETTING

The provinces of North Karelia and Kuopio in eastern Finland.

PARTICIPANTS

Random samples of working age people (n=21 302) from the population register.

MAIN RESULTS

For self rated health, the age adjusted poor to good relative risk for all cause mortality was 2.36 (95% confidence intervals 2.10, 2.64) for men and 1.90 (1.63, 2.22) for women, and for cardiovascular mortality 2.29 (1.96, 2.68) for men and 2.34 (1.84, 2.96) for women. Adjusted for selected potentially fatal diseases from the subjects' medical histories, cardiovascular disease risk factors, and education, the corresponding relative risks for all cause mortality were 1.66 (1.47, 1.88) for men and 1.50 (1.26, 1.78) for women, and for cardiovascular mortality 1.54 (1.29, 1.82) for men and 1.63 (1.26, 2.10) for women. The association between self rated health and mortality attributable to external causes was fairly strong.

CONCLUSIONS

Poor self rated health is a strong predictor of mortality, and the association is only partly explained by medical history, cardiovascular disease risk factors, and education.

Sex differences in genetic and environmental factors contributing to body-height

Sex differences in the heritability of self-reported body-height in two Finnish twin cohorts were studied by using sex-limitation models. The first cohort was born in 1938-1949 (N = 4873 twin pairs) and the second in 1975-1979 (N = 2374 twin pairs). Body-height was greater in the younger cohort (difference of 3.1 cm for men and 2.9 cm for women). The heritability estimates were higher among men (h2 = 0.87 in the older cohort and h2 = 0.82 in the younger cohort) than women (h2 = 0.78 and h2 = 0.67, respectively). Sex-specific genetic factors were not statistically significant in either cohort, suggesting that the same genes contribute to variation in body height for both men and women. The stronger contribution of environmental factors to body-height among women questions the hypothesis that women are better buffered against environmental stress, at least for this phenotype.

Genetic and environmental contributions to the association between body height and educational attainment: a study of adult Finnish twins

The nature of the association between body height and educational attainment found in previous studies remains to be clarified. The aim of this study was to examine factors contributing to this association by using a large Finnish twin data set (8798 adult twin pairs) gathered by questionnaire in 1981. A bivariate twin analysis was used to determine whether the genetic and environmental factors behind body height and educational attainment correlate with each other. A high heritability was found for body height (h2 = 0.78 in men and h2 = 0.75 in women), and a moderate heritability for education (h2 = 0.47 and h2 = 0.43, respectively). Shared environmental effects were also important in body height (c2 = 0.12 in men and c2 = 0.11 in women) and education (c2 = 0.36 and c2 = 0.43, respectively). A high correlation (r(c) = 0.77 in men, r(c) = 0.58 in women) of shared environmental factors education and body height, and weaker correlations (r = 0.11 and r = 0.08, respectively) of unshared environmental factors were found. The correlation of genetic factors between these two characteristics was not statistically significant. The results suggest that the association between body height and education is due mainly to nongenetic family factors.

Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries

PRIMARY OBJECTIVES

This paper aims to provide an overview of variations in average height between 10 European countries, and between socio-economic groups within these countries.

DATA AND METHODS

Data on self-reported height of men and women aged 20-74 years were obtained from national health, level of living or multipurpose surveys for 1987-1994. Regression analyses were used to estimate height differences between educational groups and to evaluate whether the differences in average height between countries and between educational groups were smaller among younger than among older birth cohorts.

RESULTS

Men and women were on average tallest in Norway, Sweden, Denmark and the Netherlands and shortest in France, Italy and Spain (range for men: 170-179 cm; range for women: 160-167 cm). The differences in average height between northern and southern European countries were not smaller among younger than among older birth cohorts. In most countries average height increased linearly with increasing birth-year (approximately 0.7-0.8 cm/5 years for men and approximately 0.4 cm/5 years for women). In all countries, lower educated men and women on average were shorter than higher educated men (range of differences: 1.6-3.0 cm) and women (range of differences: 1.2-2.2 cm). In most countries, education-related height differences were not smaller among younger than among older birth cohorts.

CONCLUSIONS

The persistence of international differences in average height into the youngest birth cohorts indicates a high degree of continuity of differences between countries in childhood living conditions. Similarly, the persistence of education-related height differences indicates continuity of socio-economic differences in childhood living conditions, and also suggests that socio-economic differences in childhood living conditions will continue to contribute to socio-economic differences in health at adult ages.

Educational differences in smoking: international comparison

OBJECTIVE

To investigate international variations in smoking associated with educational level.

DESIGN

International comparison of national health, or similar, surveys.

SUBJECTS

Men and women aged 20 to 44 years and 45 to 74 years.

SETTING

12 European countries, around 1990.

MAIN OUTCOME MEASURES

Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level.

RESULTS

In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal.

CONCLUSIONS

These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

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.

Relative effect of genetic and environmental factors on body height: differences across birth cohorts among Finnish men and women

OBJECTIVES

This study examined the change in heritability of adult body height across birth cohorts in Finland.

METHODS

In 1981, cross-sectional questionnaires were completed by 10,968 twin pairs born before 1958. The effect of genetic factors was estimated via genetic modeling.

RESULTS

Heritability increased from the cohort born before 1929 (0.76, 95% confidence interval [CI] = 0.65, 0.88 in men; 0.66, 95% CI = 0.55, 0.77 in women) to that born in 1947 through 1957 (0.81, 95% CI = 0.73, 0.87 in men; 0.82, 95% CI = 0.75, 0.89 in women).

CONCLUSIONS

Heritability of height increased across Finnish birth cohorts born in the first half of this century and leveled off after World War II. Environmental factors, compared with genetic factors, appear to be more important among women than men.

Social background, adult body-height and health

STUDY OBJECTIVE

To study the socio-demographic determinants of body-height and the bearing of these determinants on the association between body-height and health among Finnish adults.

DATA AND METHOD

Cross-sectional population survey including questions on social background, body-height and health, and retrospective questions on childhood living conditions. The data derive from a representative Survey on Living Conditions collected by Statistics Finland in 1994. The response rate was 73%. Male and female respondents > or =20 years were included in the analysis (N = 8212). Statistical methods include regression analysis and logistic regression analysis.

RESULTS

Body-height was strongly associated with year of birth, region, childhood living conditions and education among adult men and women. Body-height was also associated with limiting long-standing illness and perceived health as below good. Tall men had the best health and short men the poorest health. Among women the association of body-height with health differed from men, as tall women showed high levels of limiting long-standing illness, notably musculo-skeletal diseases. Adjusting for the background variables weakened but did not abolish the association between poor health and short stature among men and women.

CONCLUSIONS

Short stature is associated with poor health among Finnish men and women. A non-linear association among women was found for musculo-skeletal diseases. The studied social background factors explained only little of the association between body-height and health.

The association of body mass index with social and economic disadvantage in women and men

BACKGROUND

Although an inverse relationship between socioeconomic status and body mass index (BMI) is well documented, broad population studies focusing on the association between BMI and various forms of disadvantage such as unemployment, low income or social isolation are rare.

METHODS

A nationwide, representative sample of 25-64-year-old Finnish subjects (n = 6016) was classified according to their BMI into four groups: 'thin' (BMI < 20), 'normal' (BMI 20-24.9), 'overweight' (BMI 25-29.9) and 'obese' (BMI > or = 30). Multivariable analyses using logistic regression were conducted with this BMI-grouping as an independent variable to predict social and economic disadvantage, controlling simultaneously for age, educational attainment, region of residence, and limiting long-standing illness.

RESULTS

In women, overweight was associated with current unemployment and obesity with long-term unemployment as well as absence of close friends outside the family circle. Both overweight and obesity were associated with low individual earnings. Obese women were also most likely to have low household disposable and individual incomes; a similar pattern was seen among thin women. A small subgroup of thin men were socially and economically disadvantaged with all our indicators whereas excess body weight was not problematic for men.

CONCLUSIONS

Deviant body weight is associated with social and economic disadvantage in a gender-specific and partly curvilinear way. In particular, obese women face multiple social and economic disadvantage.

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.

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.

Socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s

Studies on health inequalities have usually focused either on mortality or on morbidity. This concerns national studies as well as international comparisons of health inequalities. This paper seeks to bridge the gap by applying health expectancy as a synthetic overall measure of health. The purpose of the study is to compare socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s. Additionally, the major methodological issues in the use of health expectancy in the study of health inequalities are identified. Data on mortality by level of education derive from linked national follow-up studies (1986-1990) of population censuses. Data on the prevalence of morbidity by level of education derive from nationally representative surveys of the noninstitutionalised adult population in 1985/87. Persons aged 25-74 years were included. Four measures of morbidity were used: limiting long-standing illness, extremely limiting long-standing illness, functional disabilities and perceived less than good health. The association between mortality/morbidity and level of education in each 5-year age/sex group was determined by a regression-based method. Partial life expectancies and partial health expectancies for ages 25-74 were then calculated by using the mortality quotients and morbidity prevalences predicted by the regression model for those at the top and the bottom of the educational hierarchy in each 5-year age group, using an application of the method first presented by Sullivan. Although various measures of health expectancy were used, the result were consistent. In absolute terms the size of socioeconomic inequalities in health expectancy in Finland and Norway is on the same level. In relative terms, however, the size of inequalities in health expectancy is greater in Norway. If one considers premature mortality to be more severe than any indicator of morbidity, the mortality morbidity mix of the health inequalities is less favourable to Finland, since the size of absolute inequalities in mortality is greater in Finland. Health expectancy measures provide a promising measure for assessing and comparing the pattern and the size of health inequalities.

Gender, socioeconomic status and family status as determinants of food behaviour

This study examines social structural and family status factors as determinants of food behaviour. The data were derived from the FINMONICA Risk Factor Survey, collected in Finland in spring 1992. A multidimensional framework of the determinants of food behaviour was used, including social structural position, family status and gender. The associations between the determinants of food behaviour were estimated by multivariate logistic regression models, adjusted for age and regional differences. Food behaviour was measured by an index including six food items which were chosen based on Finnish dietary guidelines. In general, women's food behaviour was more in accordance with the dietary guidelines than that of men. The pattern of association between educational level and food behaviour was similar for both genders, but slightly stronger for men than women. Employment status was associated only with women's food behaviour, but the tendency was the same for men. Marital status was associated with men's as well as women's food behaviour. The food behaviour of married men and women was more in line with the dietary guidelines than the food behaviour of those who had been previously married. Parental status, however, was only associated with women's food behaviour, that is, the food behaviour of women with young children was more closely in line with the dietary guidelines than that of the rest of the women.

Body mass and social class: a comparison of Finland and Sweden in the 1990s

High physical weight affects public health as well as people's social relations. This study seeks to examine the distribution of physical weight across the social structure in Finland and Sweden in the early 1990s. We compare physical weight, classified by overweight and obesity, 1) between men and women, 2) between different age groups, and 3) between social classes in these two countries. Comparable interview surveys were conducted in Finland 1994 (N = 8,650, response rate 73%) and in Sweden 1991 (N = 5,306, response rate 79%). Physical weight, overweight and obesity of populations are described in terms of body mass index (BMI = weight (kg)/height (m2)). The average BMI is higher in Finnish men (25.6) and women (24.6) than in their Swedish counterparts (24.6 and 23.2, respectively). In both countries, the average BMI is higher in men than in women below the age of about 55-64 years. In both countries and in both genders the average BMI is higher, the higher the age. The level of overweight as well as obesity is lower in Sweden than in Finland. Social class differences can be found in both countries. The odds ratio for overweight is higher in Finnish male and female farmers (OR = 1.57 and 1.94, respectively) as compared to upper white collars (OR = 1.0). In Sweden, high odds ratio for overweight can be found among male entrepreneurs (OR = 1.80) and female unskilled manuals (OR = 2.65). Obesity varies by social class in Swedish men and women as well as in Finnish women, but not in Finnish men. The results show that Finnish men and women are more often overweight and obese than their Swedish counterparts, but social class differences in overweight and obesity are larger in Sweden than in Finland.

Differences in self reported morbidity by educational level: a comparison of 11 western European countries

STUDY OBJECTIVE

To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels.

DESIGN AND METHODS

National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality.

MAIN RESULTS

The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator.

CONCLUSIONS

Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.

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.

Changes in health status and health behavior among Finnish adults 1978-1993

The patterning of trends in self-assessed health, and in the "Holy Four" of health-related behaviors, that is, smoking, drinking, the use of high-fat milk and butter, and physical exercise, was examined in the Finnish general population aged 25-64 years. There were considerable differences in the health status and health behavior by study year, gender, and educational attainment. The longer the education, the better the health and the more favorable the health behavior, except for the use of alcohol. From the late 1970s to the early 1990s smoking increased slightly among women but decreased among men. The use of alcohol increased, whereas the use of butter and high-fat milk decreased dramatically. Physical exercise during leisure time increased, especially among women. Unemployed men and women were more often smokers than employed persons.