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Piiroinen I, Tuomainen TP, Tolmunen T, Kraav SL, Jarroch R, Voutilainen A. Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland. Soc Sci Med 2023; 332:116127. [PMID: 37531907 DOI: 10.1016/j.socscimed.2023.116127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Abstract
A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession.
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Affiliation(s)
- Ilkka Piiroinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland; School of Social Services and Health Care, Tampere University of Applied Sciences, Finland.
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Tommi Tolmunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland; Department of Adolescent Psychiatry, Kuopio University Hospital, Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, Finland
| | - Siiri-Liisi Kraav
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Finland; Department of Social Sciences, University of Eastern Finland, Finland
| | - Rand Jarroch
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
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Figueiredo DCMMD, Sanchéz-Villegas P, Figueiredo AMD, Moraes RMD, Daponte-Codina A, Schmidt Filho R, Vianna RPDT. Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis. Rev Bras Enferm 2022; 75Suppl 3:e20210778. [PMID: 35703676 DOI: 10.1590/0034-7167-2021-0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession. METHODS interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data. RESULTS there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide. CONCLUSIONS the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.
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Jarroch R, Tajik B, Tuomainen TP, Kauhanen J. Economic Recession and the Long Term Risk of Psychiatric Disorders and Alcohol Related Diseases-A Cohort Study From Eastern Finland. Front Psychiatry 2022; 13:794888. [PMID: 35250662 PMCID: PMC8891480 DOI: 10.3389/fpsyt.2022.794888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Long-term development of psychiatric disorders and alcohol-related diseases after economic recessions is insufficiently studied. We investigated the overall impact of the economic recession between 1991 and 1994 in Finland on the long-term incidence of psychiatric and alcohol-related diseases. METHODS A population-based sample of 1,774 women and men aged 53-73 years were examined between 1998 and 2001 from the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Participants completed comprehensive questionnaires on the possible impact of the 1990s recession in Finland on their lives. They were followed-up until 2018. Cox proportional hazards regression was used to estimate hazard ratios (HR) of new incident psychiatric and alcohol-related disorders during the 20-years follow-up after linkage to the National Hospital Registry. Logistic regression was used to estimate odds ratios (OR) of psychiatric disorders at baseline. RESULTS At baseline, 93 participants had psychiatric disorders. During 20-years follow-up, 138 new psychiatric disorders and 45 alcohol-related diseases were developed. The covariate-adjusted risk of psychiatric disorders was over twice higher among men who experienced recession-induced hardships compared to those who did not (HR = 2.20, 95%CI = 1.04-4.70, p = 0.04). The risk of alcohol-related diseases was more than four times higher among men with hardships (HR = 4.44, 95%CI = 1.04-18.90, p = 0.04). No such associations were observed among women. No association was observed between recession-induced hardships and having psychiatric disorders at baseline in both genders (multivariate-adjusted p = 0.63 for women, multivariate-adjusted p = 0.36 for men). CONCLUSION Long-term risk of psychiatric disorders and alcohol-related diseases was increased after the 1990s economic recession in Finland, but only among middle-age and older men.
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Affiliation(s)
- Rand Jarroch
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Behnam Tajik
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Figueiredo DCMMD, Sanchéz-Villegas P, Figueiredo AMD, Moraes RMD, Daponte-Codina A, Schmidt Filho R, Vianna RPDT. Efeitos da recessão econômica na mortalidade por suicídio no Brasil: análise com séries temporais interrompidas. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0778pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: analisar as tendências nas taxas de suicídio no Brasil, no período antes e depois do início da recessão econômica. Métodos: estudo de séries temporais interrompidas utilizando dados nacionais de suicídio registrados no período entre 2012 e 2017 com análises por subgrupos socioeconômicos. Modelo de regressão quasi-Poisson foi empregado para analisar as tendências dos dados ajustados sazonalmente. Resultados: observou-se aumento abrupto no risco de suicídio após recessão econômica na população com menor escolaridade (12,5%; RR = 1,125; IC95%:1,027; 1,232) e na Região Sul (17,7%; 1,044; 1,328). Após redução abrupta, ocorreu aumento progressivo no risco para a população de pretos e pardos e na de maior escolaridade. Na maioria dos demais estratos populacionais, verificou-se aumento progressivo no risco de suicídio. Conclusões: a recessão econômica brasileira produziu efeitos diferentes nas taxas de suicídio, considerando os estratos sociais, o que demanda estratégias de saúde e políticas sensíveis às populações mais vulneráveis.
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Bauer A, Garman E, McDaid D, Avendano M, Hessel P, Díaz Y, Araya R, Lund C, Malvasi P, Matijasevich A, Park AL, Paula CS, Ziebold C, Zimmerman A, Evans-Lacko S. Integrating youth mental health into cash transfer programmes in response to the COVID-19 crisis in low-income and middle-income countries. Lancet Psychiatry 2021; 8:340-346. [PMID: 33549174 PMCID: PMC9215313 DOI: 10.1016/s2215-0366(20)30382-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
Social protection measures can play an important part in securing livelihoods and in mitigating short-term and long-term economic, social, and mental health impacts of the COVID-19 pandemic. In particular, cash transfer programmes are currently being adapted or expanded in various low-income and middle-income countries to support individuals and families during the pandemic. We argue that the current crisis offers an opportunity for these programmes to focus on susceptible young people (aged 15-24 years), including those with mental health conditions. Young people living in poverty and with mental health problems are at particular risk of experiencing adverse health, wellbeing, and employment outcomes with long-term consequences. They are also at risk of developing mental health conditions during this pandemic. To support this population, cash transfer programmes should not only address urgent needs around food security and survival but expand their focus to address longer-term mental health impacts of pandemics and economic crises. Such an approach could help support young people's future life chances and break the vicious cycle between mental illness and poverty that spirals many young people into both socioeconomic and mental health disadvantage.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Mauricio Avendano
- Department of Global Health & Social Medicine, King's College London, London, UK; Department of Social and Behavioural Sciences, Harvard School of Public Health Boston, Massachusetts, MA, USA
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, Colombia
| | - Yadira Díaz
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, Colombia
| | - Ricardo Araya
- Centre for Global Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Centre for Global Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paulo Malvasi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Public Health, São Paulo, Brasil
| | - Alicia Matijasevich
- Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brasil
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cristiane Silvestre Paula
- Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, Brasil
| | - Carolina Ziebold
- Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, Brasil
| | - Annie Zimmerman
- Department of Global Health & Social Medicine, King's College London, London, UK; Centre for Global Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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Jarroch R, Tajik B, Tuomainen TP, Kauhanen J. ECONOMIC RECESSION AND THE RISK OF CANCER - A Cohort Study from Eastern Finland. J Epidemiol 2021; 32:384-390. [PMID: 33716271 PMCID: PMC9263616 DOI: 10.2188/jea.je20200595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BackgroundLittle is known about the role of economic recessions in the risk of cancer. Therefore, we evaluated the impact of the severe economic recession in Finland between 1991-1994 on the incidence of all cancers and cancer subtypes among middle-age and older population.MethodsFrom the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), a population-based sample of 1620 women and men aged 53-73 years were examined between 1998-2001. The cancer-free participants completed a questionnaire on the possible impact of the 1990s recession in Finland on their lives. Incident cases of cancer were obtained through record linkage with the Finnish Cancer Registry. Cox proportional hazards regression was used to estimate hazard ratios (HR) of incident cancer events after adjusting for possible confounders.ResultsA total of 1096 cancer-free participants had experienced socioeconomic hardships due to the recession at the baseline. During 20 years of follow-up, 473 participants developed cancer. After adjustment for age, baseline socioeconomic position and lifestyle factors, the risk of all cancers was 32% higher among men who experienced socioeconomic hardships compared to those who did not (HR 1.32, 95%CI, 0.99-1.75, p=0.05). Prostate-genital cancer was 71% higher among men with hardships (n=103, HR=1.71, 95%CI, 1.06-2.74, p=0.02). No association was observed between socioeconomic hardships and subsequent risk of total or any subtype of cancer among women.Conclusions:The 1990s economic recession was associated with increased risk of all cancers, especially prostate-genital cancer among Finnish middle-age and older men, but no association with cancer was observed in women.
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Affiliation(s)
- Rand Jarroch
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Behnam Tajik
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Tomi-Pekka Tuomainen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Jussi Kauhanen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
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Ziebold C, de Jesus Mari J. The COVID-19 pandemic: Challenges to prevent suicide in megacities. Indian J Med Res 2021; 152:325-328. [PMID: 33380695 PMCID: PMC8061586 DOI: 10.4103/ijmr.ijmr_3992_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Carolina Ziebold
- Postgraduate Program in Developmental Disorders, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry & Medical Psychology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Leinsalu M, Baburin A, Jasilionis D, Krumins J, Martikainen P, Stickley A. Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000-2015: A register-based study. J Psychiatr Res 2020; 131:138-143. [PMID: 32971357 DOI: 10.1016/j.jpsychires.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. This study aimed to examine changes and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in relation to macroeconomic fluctuations. METHODS We analysed changes in overall suicide mortality and by educational level between the 2000-2003, 2004-2007, 2008-2011 and 2012-2015 periods among men aged 30-64 years using census-linked longitudinal mortality data. We estimated age-standardised mortality rates, mortality rate ratios (Poisson regression), the relative index of inequality and slope index of inequality. RESULTS Overall suicide mortality fell markedly from 2000-2003 to 2004-2007. The decline was largest among high educated men in the Baltic countries and among middle and low educated men in Finland. From 2004-2007 to 2008-2011, the positive trend slowed and while suicide mortality continued to fall among middle and low educated men, it increased somewhat among high educated men in all Baltic countries. In Finland, suicide mortality decreased among the high educated and increased slightly among low educated men. CONCLUSIONS In the Baltic countries, lower educated men had a smaller decline in suicide mortality than higher educated men during a period of rapid economic expansion, however, they were not more disadvantaged during the recession, possibly because of being less exposed to financial loss. Consequently, relative inequalities in suicide mortality may increase during economic booms and decrease during recessions.
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Affiliation(s)
- Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden; Department of Epidemiology and Biostatistics, National Institute for Health Development, Estonia.
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Estonia
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Rostock, Germany; Demographic Research Centre, Vytautas Magnus University, Kaunas, Lithuania
| | - Juris Krumins
- Demography unit, Faculty of Business, Management and Economics, University of Latvia, Riga, Latvia
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany; Population Research Unit, University of Helsinki, Helsinki, Finland; Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden
| | - Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden; Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
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Regidor E, Ronda E, Tapia Granados JA, Pulido J, de la Fuente L, Barrio G. Reversal of Upward Trends in Mortality During the Great Recession by Employment Status at Baseline in a National Longitudinal Study. Am J Epidemiol 2019; 188:2004-2012. [PMID: 31241161 DOI: 10.1093/aje/kwz150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Because of the healthy worker effect, mortality rates increased in individuals who were employed and those who were unemployed, and decreased in those economically inactive at baseline in reported studies. To determine if such trends continue during economic recessions, we analyzed mortality rates in Spain before and during the Great Recession in these subgroups. We included 21,933,351 individuals who were employed, unemployed, or inactive in November 2001 and aged 30-64 years in each calendar-year of follow-up (2002-2011). Annual age-adjusted mortality rates were calculated in each group. The annual percentage change in mortality rates adjusted for age and educational level in employed and unemployed persons were also calculated for 2002-2007 and 2008-2011. In employed and unemployed men, mortality rates increased until 2007 and then declined, whereas in employed and unemployed women, mortality rates increased and then stabilized during 2008-2011. The mortality rate among inactive men and women decreased throughout the follow-up. In the employed and the unemployed, the annual percentage change was reversed during 2008-2011 compared with 2002-2007 (-1.2 vs. 3.2 in employed men; -0.3 vs. 4.1 in employed women; -0.8 vs. 2.9 in unemployed men; and -0.6 vs. 1.3 in unemployed women). The upward trends in mortality rates among individuals who were employed or unemployed in 2001 were reversed during the Great Recession (2008-2011).
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Regidor E, Ronda E, Tapia Granados JA, Viciana-Fernández FJ, de la Fuente L, Barrio G. Trends in disease mortality before and during the Great Recession in individuals employed in Spain in 2001. Eur J Public Health 2019; 29:954-959. [PMID: 30851096 DOI: 10.1093/eurpub/ckz025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies on economic recessions and mortality due to cancer and other chronic diseases have yielded inconsistent findings. We investigated the trend in all-disease mortality and mortality due to several specific diseases before and during the Great Recession of 2008 in individuals who were employed in 2001, at the beginning of follow-up. METHODS We follow in a nationwide longitudinal study over 15 million subjects who had a job in Spain in 2001. The analysed outcomes were mortality at ages 25-64 years due to all diseases, cancer and other chronic diseases. We calculated annual mortality rates from 2003 to 2011, and the annual percentage change (APC) in mortality rates during 2003-07 and 2008-11, as well as the effect size, measured by the APC difference between the two periods. RESULTS All-disease mortality increased from 2003 to 2007 in both men and women; then, between 2008 and 2011, all-disease mortality decreased in men and reached a plateau in women. In men, the APC in the all-disease mortality rate was 1.6 in 2003-07 and -1.4 in 2008-11 [effect size -3.0, 95% confidence interval (CI) -3.7 to -2.2]; in women it was 2.5 and -0.3 (effect size -2.8, 95% CI -4.2 to -1.3), respectively. Cancer mortality and mortality due to other chronic diseases revealed similar trends. CONCLUSIONS In the group of individuals with a job in 2001 the Great Recession reversed or stabilized the upward trend in all-disease mortality.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Ronda
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad de Alicante, Alicante, Spain
| | | | | | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
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Saito T, Oksanen T, Shirai K, Fujiwara T, Pentti J, Vahtera J. Combined Effect of Marriage and Education on Mortality: A Cross-national Study of Older Japanese and Finnish Men and Women. J Epidemiol 2019; 30:442-449. [PMID: 31495811 PMCID: PMC7492707 DOI: 10.2188/jea.je20190061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background While marriage and education help maintain older adults’ health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and education on the mortality of older Japanese and Finnish adults. Methods Data on 22,415 Japanese and 11,993 Finnish adults, aged 65–74 years, were obtained from the Japan Gerontological Evaluation Study of 2010–2012 and the Finnish Public Sector Study of 2008–2009 and 2012–2013. We followed up on respondents’ survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized. Results The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.21–1.79 for Japanese and HR 1.94; 95% CI, 1.29–2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21–2.83) and Finland (HR 2.21; 95% CI, 1.26–3.89), when adjusted for baseline age, health-related behaviors, and illnesses. Conclusions Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.
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Affiliation(s)
- Tami Saito
- Department of Social Science, National Center for Geriatrics and Gerontology
| | | | | | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital
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Leinsalu M, Reile R, Stickley A. Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-2016. J Epidemiol Community Health 2019; 73:1026-1032. [PMID: 31406016 PMCID: PMC6877707 DOI: 10.1136/jech-2018-211939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/06/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022]
Abstract
Background In the 2000s, the Baltic countries experienced unprecedented credit-driven economic growth that was followed by a deep recession. This study examined the impact of profound macroeconomic changes on population mental health in Estonia in 2004–2016. Methods Data on 17 794 individuals in the 20–64 age group were obtained from seven nationally representative cross-sectional surveys. The prevalence of past 30-day depression was calculated for men and women further stratified by sociodemographic characteristics. Multivariable regression analysis was used to assess whether these characteristics were associated with the yearly variation in depression. Results In 2006, the adjusted prevalence ratio for depression was 0.77 (95% CI 0.64 to 0.93) for men and 0.85 (95% CI 0.74 to 0.97) for women as compared with 2004; in 2010, the prevalence ratio as compared with 2008 for both men and women was 1.22 (95% CIs 1.04 to 1.43 and 1.09 to 1.37, respectively). Among men, the increase in the prevalence of depression in 2008–2010 was statistically significant for 35–64 year olds, ethnic Estonians, those who were married, mid-educated or were employed, whereas among women, a significant increase was observed in 50–64 year olds, Estonians and non-Estonians, those who were not-married, were highly educated or mid-educated, in the mid-income group or were employed. Conclusions Population mental health is responsive to macroeconomic changes. In less wealthy high-income countries, the greater impact of recession on depression among advantaged groups may relate to a higher debt burden coupled with job insecurity.
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Affiliation(s)
- Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden .,Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Rainer Reile
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.,Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Unemployment and cause-specific mortality among the Belgian working-age population: The role of social context and gender. PLoS One 2019; 14:e0216145. [PMID: 31048926 PMCID: PMC6497266 DOI: 10.1371/journal.pone.0216145] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background Life expectancy increased in industrialized countries, but inequalities in health and mortality by socioeconomic position (SEP) still persist. Several studies have documented educational inequalities, yet the association between health and employment status remains unclear. However, this is an important issue considering the instability of the labour market and the fact that unemployment now also touches ‘non-traditional groups’ (e.g. the high-educated). This study will 1) probe into the association between unemployment and cause-specific mortality; 2) look into the possible protective effect of sociodemographic variables; 3) assess the association between unemployment, SEP, gender and cause-specific mortality. Material and methods Individually linked data of the Belgian census (2001) and Register data on emigration and cause-specific mortality during 2001–2011 are used. The study population contains the Belgian population eligible for employment at census, based on age (25–59 years) and being in good health. Both absolute and relative measures of all-cause and cause-specific mortality by employment status have been calculated, stratified by gender and adjusted for sociodemographic and socioeconomic indicators. Results Unemployed men and women were at a higher risk for all-cause and cause-specific mortality compared with their employed counterparts. The excess mortality among unemployed Belgians was particularly high for endocrine and digestive diseases, mental disorders, and falls, and more pronounced among men than among women. Other indicators of SEP did only slightly decrease the mortality disadvantage of being unemployed. Discussion The findings stress the need for actions to ameliorate the health status of unemployed people, especially for the most vulnerable groups in society.
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Mackenbach JP, Valverde JR, Artnik B, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, Rychtaříková J, Rodriguez-Sanz M, Vineis P, White C, Wojtyniak B, Hu Y, Nusselder WJ. Trends in health inequalities in 27 European countries. Proc Natl Acad Sci U S A 2018; 115:6440-6445. [PMID: 29866829 PMCID: PMC6016814 DOI: 10.1073/pnas.1800028115] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.
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Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands;
| | - José Rubio Valverde
- Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Barbara Artnik
- Department of Public Health, Faculty of Medicine, 1000 Ljubljana, Slovenia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8006 Zurich, Switzerland
| | | | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, 1050 Ixelles, Belgium
| | - Ramune Kalediene
- Lithuanian University of Health Sciences, Kaunas 44307, Lithuania
| | | | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, 89 Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, 11619 Tallinn, Estonia
| | - Pekka Martikainen
- Department of Sociology, University of Helsinki, 00100 Helsinki, Finland
| | - Gwenn Menvielle
- INSERM, Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), 75646 Paris, France
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jitka Rychtaříková
- Department of Demography, Charles University, 128 43 Prague 2, Czech Republic
| | | | - Paolo Vineis
- Medical Research Council-Public Health England Centre for Environment and Health, School of Public Health, Imperial College, London W2 1PG, United Kingdom
| | - Chris White
- Office of National Statistics, Newport NP10 8XG, United Kingdom
| | - Bogdan Wojtyniak
- Department of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, 00-791 Warsaw, Poland
| | - Yannan Hu
- Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
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