Cause-specific mortality at young ages: lessons from Finland

Psychiatric disorders and mortality due to external causes following diagnosis of endometriosis at a young age: a longitudinal register-based cohort study in Finland

BACKGROUND

Endometriosis diagnosed in adults is associated with increased risk of various psychiatric disorders. However, little is known concerning psychiatric comorbidity and mortality due to external causes associated with endometriosis diagnosed at a young age.

OBJECTIVE

This longitudinal cohort study aimed to investigate the link between surgical diagnosis of endometriosis at a young age and subsequent psychiatric disorders and mortality due to external causes. In addition, we compared the occurrence of the most common psychiatric disorders between different sites of surgically confirmed endometriosis (ovarian vs other) because of possible differences in pain manifestations.

STUDY DESIGN

We conducted a retrospective register-based cohort study. Altogether 4532 women with surgically confirmed diagnosis of endometriosis before the age of 25 years from 1987 to 2012 were identified from the Finnish Hospital Discharge Register. They were matched with women without surgically diagnosed endometriosis for age and municipality on the index day (n=9014). Women were followed up from the index day until the end of 2019 for the outcomes of interest, which included 9 groups of psychiatric disorders (inpatient episodes since 1987, outpatient episodes since 1998) and death due to external causes, including deaths due to accidents, suicides, and violence (Finnish Register of Causes of Death). Cox proportional hazard models were applied to assess the crude and parity-adjusted hazard ratios and 95% confidence intervals.

RESULTS

The cohort's median age was 22.9 years (interquartile range, 21.3-24.1) at the beginning and 42.5 years (36.7-48.3) after a median follow-up time of 20.0 years (14.5-25.7). We observed a higher hazard of depressive, anxiety, and bipolar disorders in women with endometriosis compared with the reference cohort, with depressive and anxiety disorders being the two most common psychiatric disorders. These differences appeared early and remained the same during the entire follow-up, irrespective of whether assessed from the data on inpatient episodes only or the data on both in- and outpatient episodes. The corresponding adjusted hazard ratios were 2.57 (95% confidence interval, 2.11-3.14) and 1.87 (1.65-2.12) for depressive disorders, 2.40 (1.81-3.17) and 2.09 (1.84-2.37) for anxiety disorders, and 1.71 (1.30-2.26) and 1.66 (1.28-2.15) for bipolar disorders, respectively. A higher hazard was observed for nonorganic sleeping disorders for the first 10 years only (3.83; 2.01-7.30) when assessed using the data on both in- and outpatient episodes. When based on inpatient records, a higher hazard for alcohol/drug dependence after 15 years of follow-up (2.07; 1.21-3.54) was observed. The difference in hazard for personality disorders tended to increase during follow-up (<10 years, 2.12 [1.28-3.52]; ≥10 years, 3.08 [1.44-6.57]). Depressive and anxiety disorders occurred more frequently in women with types of endometriosis other than ovarian endometriosis. No difference in deaths due to external causes was observed between the endometriosis and reference cohorts.

CONCLUSION

Surgical diagnosis of endometriosis at a young age was associated with increased incidence of several psychiatric disorders. Moreover, within the endometriosis population, psychiatric comorbidity was more common in women with types of endometriosis other than ovarian endometriosis. We speculate that chronic pain is essential in the development of these psychiatric disorders, and that early and effective pain management is important in reducing the risk of psychiatric morbidity in young women. More research concerning the associations and management of endometriosis and associated psychiatric disorders is warranted.

What Can We Learn from the Functional Clustering of Mortality Data? An Application to the Human Mortality Database

This study analyzed whether there are different patterns of mortality decline among low-mortality countries by identifying the role played by all the mortality components. We implemented a cluster analysis using a functional data analysis (FDA) approach, which allowed us to consider age-specific mortality rather than summary measures, as it analyses curves rather than scalar data. Combined with a functional principal component analysis, it can identify what part of the curves is responsible for assigning one country to a specific cluster. FDA clustering was applied to the data from 32 countries in the Human Mortality Database from 1960 to 2018 to provide a comprehensive understanding of their patterns of mortality. The results show that the evolution of developed countries followed the same pattern of stages (with different timings): (1) a reduction of infant mortality, (2) an increase of premature mortality and (3) a shift and compression of deaths. Some countries were following this scheme and recovering the gap with precursors; others did not show signs of recovery. Eastern European countries were still at Stage (2), and it was not clear if and when they will enter Stage 3. All the country differences related to the different timings with which countries underwent the stages, as identified by the clusters.

Sixfold Post-Fracture Mortality in 16- To 30-Year-Old Patients-Suicides, Homicides, and Intoxications Among Leading Causes of Death

BACKGROUND AND AIMS:

The death of any young individual is associated with the loss of many potentially fulfilling years of life. It has been suggested that the relative mortality of fracture patients may be higher in younger age groups than in older cohorts. We determined the mortality and causes of death in a cohort of 16- to 30-year-old patients that had been hospitalized for fractures.

MATERIAL AND METHODS:

We collected data using criteria based on the diagnosis code (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), surgical procedure code (Nordic Medico-Statistical Committee), and seven additional characteristics of patients admitted to the trauma ward at the Central Finland Hospital between 2002 and 2008. Patients were then followed to ascertain their mortality status until the end of 2012. Standardized mortality ratios were calculated and causes of death were determined by combining our registry data with data provided by Statistics Finland.

RESULTS:

During the study, 199 women and 525 men aged 16-30 years had sustained fractures. None of these patients died during the primary hospital stay. At the end of follow-up (mean duration 7.4 years), 6 women and 23 men had died. The standardized mortality ratio for all patients was 6.2 (95% Confidence Interval: 4.3-8.9). Suicides and intoxications comprised over half, and motor vehicle accidents and homicides comprised nearly a third of the post-fracture deaths.

CONCLUSION:

We found a concerning increase in mortality among young adults that had been hospitalized due to a fracture compared to the general population that had been standardized by age, sex, and calendar-period. Leading causes of death were suicides and intoxications or motor vehicle accidents and homicides, which may be indicative of depressive disorders or impulse control disorders, respectively. Identification of the underlying psychosocial problems may provide an opportunity for preventive interventions.

Life expectancy gap between the Francophone majority and Anglophone minority of a Canadian population

Language is an important determinant of health, but analyses of linguistic inequalities in mortality are scant, especially for Canadian linguistic groups with European roots. We evaluated the life expectancy gap between the Francophone majority and Anglophone minority of Québec, Canada, both over time and across major provincial areas. Arriaga's method was used to estimate the age and cause of death groups contributing to changes in the life expectancy gap at birth between 1989-1993 and 2002-2006, and to evaluate patterns across major provincial areas (metropolitan Montréal, other metropolitan centres, and small cities/rural areas). Life expectancy at birth was greater for Anglophones, but the gap decreased over time by 1.3 years (52% decline) in men and 0.9 years (47% decline) in women, due to relatively sharper reductions in Francophone mortality from several causes, except lung cancer which countered reductions in women. The life expectancy gap in 2002-2006 was widest in other metropolitan centres (men 5.1 years, women 3.2 years), narrowest in small cities/rural areas (men 0.8 years, women 0.7 years), and tobacco-related causes were the main contributors. Only young Anglophones <40 years in small cities/rural areas had mortality higher than Francophones, resulting in a narrower gap in these areas. Differentials in life expectancy favouring Anglophones decreased over time, but varied across areas of Québec. Tobacco-related causes accounted for the majority of the current life expectancy gap.

Family origin and mortality: prospective Finnish cohort study

Background

Death rates are notably higher in eastern Finland than in western Finland, and life expectancy of Finnish speakers shorter than that of Swedish speakers. The mortality differences correspond to recent genetic mappings of the population and are prominent for causes of death that are known to be associated with genetic risk factors.

Methods

Using intergenerational data, we studied the impact of parental birth area on all-cause mortality risks of middle-aged men in Finland 1985-2003, assuming that geographic family origin reflects genetic predisposition to complex disorders. Relative death risks at ages 30-49 years were estimated by parental birth region and ethnicity, according to Cox regressions standardised for own education, family type at childhood, and year of birth.

Results

The death risk of Finnish speakers born in eastern Finland was 1.13 (95% confidence interval 1.01 to 1.26) that of Finnish speakers born in western Finland, whereas that of Swedish speakers was only 0.60 (0.52 to 0.71). In Finnish speakers, the effects of own birth area and area of residence disappeared when parental birth area was accounted for. The death risk of persons with at least one parent born in eastern Finland was 1.23 (1.09 to 1.39) that of people with both parents born in western Finland.

Conclusions

Parental birth area is the driving force behind the regional mortality difference in Finland. The findings highlight and give further support for the potentially important role of genetic risk factors in mortality. Close monitoring of persons' geographic and ethnic ancestry may promote public health and avoid many early deaths.

Forced migration and mortality in the very long term: did perestroika affect death rates also in Finland?

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

Internal migration and mortality: the case of Finland

In light of possibilities and limitations of data from the Finnish population register, and the general demographic development of Finland, this paper illuminates the complex interrelation between internal migration and mortality. We explore the roles played by health selection, birth region, and migration as a potentially harmful event. A five per cent random sample from a longitudinal data file that contains deaths for a period of 24 years is used. The focus is on people aged 40-59 years living in Southern Finland, who are defined by birth region and time since immigration. We find some indications of a healthy-migrant effect, but also that migrants may have integration difficulties or that they are negatively selected with regard to health behaviours and lifestyles. In line with previous studies on Finland, birth region is found to be a very decisive mortality determinant.