Avoidable mortality in Estonia: exploring the differences in life expectancy between Estonians and non-Estonians in 2005-2007

Circulatory diseases and the wide sex and ethnic life expectancy gaps in Bulgaria since 2010

OBJECTIVES

Despite extensive public health initiatives, Bulgaria still has the lowest life expectancy at birth (LE) in the European Union. Sex and ethnic differences in LE and mortality are also exceptionally large. We aimed to identify what causes of death drive these wide disparities and thus provide clear targets for future public health interventions.

DESIGN AND METHODS

We conducted a retrospective analysis of mortality rates from 2010 to 2022 to assess sex disparities in LE by age and cause of death. Combining mortality data with the 2021 Bulgarian census also allowed us to study LE disparities among the three main ethnic groups (Bulgarians, Turks, and Roma). We implemented standard demographic decomposition methods to quantify the role of seven major causes of death on LE disparities.

RESULTS

We found that the difference between male and female LE has persisted for around seven years. Circulatory diseases contribute 3.66 years, or around 50% of the male-female gap. Ethnic LE disparities are larger for women than for men. Circulatory diseases account for more than 60% of these ethnic LE gaps. COVID-19 mortality explained between 0.5 and 1.1 years of the male-female gap. We found minimal differences in COVID-19 mortality across ethnic groups in Bulgaria.

CONCLUSION

In Bulgaria, circulatory diseases contributed more to both the sex and ethnic LE gaps than in any other previously studied country. Our findings suggest that future public health policy initiatives should focus on circulatory diseases to narrow the Bulgarian LE disparities. One possible target for such a policy would be to reduce excessive smoking and alcohol consumption.

Comparing the cognitive functioning of middle-aged and older foreign-origin population in Estonia to host and origin populations

Background

In migration and health research, the healthy migrant effect has been a common finding, but it usually pertains to specific contexts only. Existing findings are inconsistent and inconclusive regarding the cognitive functioning of the (aging) foreign-origin population relative to the populations of their host and sending countries. Moreover, this comparison is an understudied design setting.

Objective

We analyze the outcomes and associations of cognitive functioning outcomes of the non-institutionalized middle-aged and older population, comparing the Russian-origin population in Estonia with Estonians in Estonia and Russians in Russia in a cross-sectional design. We aim to estimate the (long-term) effects of migration on cognitive functioning in later life, contextualizing the findings in previous research on the healthy migrant effect.

Data and methods

We use data from face-to-face interviews conducted within the SHARE Estonia (2010-2011) and SAGE Russia (2007-2010) surveys. Respondents aged 50+ living in urban areas were grouped by self-identified ethnicity, including 2,365 Estonians, 1,373 Russians in Estonia, and 2,339 Russians in Russia (total N = 6,077). Cognitive functioning was measured using a 25-percentile cut-off threshold for the results of two cognition outcomes - immediate recall and verbal fluency - and the odds of impairment were estimated using binary logistic regression.

Results

Russian men and women living in Estonia have significantly higher odds of impairment in immediate recall than Estonian men and women, though they do not differ from Russians in Russia in the final adjusted models. The differences between all groups are non-significant if age at migration is considered. There are no significant differences between the groups in verbal fluency.

Conclusion

Contrary to the commonly found healthy migrant effect, the middle-aged and older foreign-origin population in Estonia fares initially worse than the native population in the immediate recall outcome, but does not differ from their sending country population, possibly due to Russia's higher mortality rate and therefore the selective survival of healthier people. Different results depending on the cognitive functioning outcome suggest that migration may affect temporary memory more than crystallized knowledge. However, there are no differences between the groups if defined based on age at migration, which suggests that the age profile differences explain most of the groups' differences in cognitive functioning.

Mothers of small-bodied children and fathers of vigorous sons live longer

Life-history traits (traits directly related to survival and reproduction) co-evolve and materialize through physiology and behavior. Accordingly, lifespan can be hypothesized as a potentially informative marker of life-history speed that subsumes the impact of diverse morphometric and behavioral traits. We examined associations between parental longevity and various anthropometric traits in a sample of 4,000-11,000 Estonian children in the middle of the 20th century. The offspring phenotype was used as a proxy measure of parental genotype, so that covariation between offspring traits and parental longevity (defined as belonging to the 90th percentile of lifespan) could be used to characterize the aggregation between longevity and anthropometric traits. We predicted that larger linear dimensions of offspring associate with increased parental longevity and that testosterone-dependent traits associate with reduced paternal longevity. Twelve of 16 offspring traits were associated with mothers' longevity, while three traits (rate of sexual maturation of daughters and grip strength and lung capacity of sons) robustly predicted fathers' longevity. Contrary to predictions, mothers of children with small bodily dimensions lived longer, and paternal longevity was not linearly associated with their children's body size (or testosterone-related traits). Our study thus failed to find evidence that high somatic investment into brain and body growth clusters with a long lifespan across generations, and/or that such associations can be detected on the basis of inter-generational phenotypic correlations.

Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004-2020

BACKGROUND

Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004-2020 and to analyse the associations between different factors in Estonia.

METHODS

Weighted data of 25-64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004-2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated.

RESULTS

Prevalence of lifetime uptake of Pap smear increased in 2004-2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25-34, 35-44, 45-54 and 55-64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking.

CONCLUSIONS

Although Pap smear uptake among 25-64 year old women increased significantly in Estonia in 2004-2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.

Age, Period and Cohort Effects On Alcohol Consumption In Estonia, 1996-2018

AIMS

To analyse the independent effects of age, period and cohort on estimated daily alcohol consumption in Estonia.

METHODS

This study used data from nationally representative repeated cross-sectional surveys from 1996 to 2018 and included 11,717 men and 16,513 women aged 16-64 years in total. The dependent variables were consumption of total alcohol and consumption by types of beverages (beer, wine and strong liquor) presented as average daily consumption in grams of absolute alcohol. Mixed-effects negative binomial models stratified by sex were used for age-period-cohort analysis.

RESULTS

Alcohol consumption was highest at ages 20-29 years for both men and women and declined in older ages. Significant period effects were found indicating that total alcohol consumption and consumption of different types of beverages had increased significantly since the 1990s for both men and women. Cohort trends differed for men and women. Men born in the 1990-2000s had significantly lower daily consumption compared to earlier cohorts, whereas the opposite was found for women.

CONCLUSION

While age-related patterns of alcohol consumption are aligned with life course stages, alcohol use has increased over the study period. Although the total daily consumption among men is nearly four times higher than among women, the cohort trends suggest convergence of alcohol consumption patterns for men and women.

Ethnic variation in self-rated health-mortality association: Results from a 17-year follow-up study in Estonia

BACKGROUND AND AIM

Previous research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH-mortality association in this setting.

MATERIALS AND METHODS

The baseline data come from the nationally representative 1996 Estonian Health Interview Survey. Individual records of 3983 respondents in the 25-79 age group were linked with mortality data with 17 years follow-up time. The association between SRH and all-cause mortality was analyzed using the Cox regression for two ethnic groups and separately for men and women.

RESULTS

Among ethnic Estonians, both men and women with bad or very bad SRH had about 60% higher mortality compared to those with good or very good SRH even after adjustment for age, socioeconomic and health-related variables. In contrast, SRH did not predict mortality among non-Estonian men and women. A strong and universal inverse association with mortality was found for personal income. Education (among men) and occupation (among women) predicted mortality only among non-Estonians, whereas ever smoking was associated with mortality in Estonian men and women. Overweight women had lower mortality risk compared to women in normal weight category.

CONCLUSIONS

We found considerable ethnic variation in SRH-mortality association and in socioeconomic predictors of mortality. Further research, preferably focusing on cause-specific mortality and reporting heterogeneity of SRH could potentially shed further light on ethnic differences in SRH-mortality association in Estonia and more generally on socioeconomic inequalities in mortality in Eastern Europe.

Comparative analysis of premature mortality among urban immigrants in Bremen, Germany: a retrospective register-based linkage study

OBJECTIVES

The main objective of this study was to explore differences in mortality patterns among two large immigrant groups in Germany: one from Turkey and the other from the former Soviet Union (FSU). To this end, we investigated indicators of premature mortality.

DESIGN

This study was conducted as a retrospective population-based study based on mortality register linkage. Using mortality data for the period 2004-2010, we calculated age-standardised death rates (SDR) and standardised mortality ratios (SMR) for premature deaths (<age 65 years). We computed years of potential life lost (YPLL) and analysed the underlying causes of death contributing to premature mortality.

SETTING AND PARTICIPANTS

In this study, we made use of the unique possibilities of register-based research in relation to migration and health. Analyses were performed in three population groups in the federal state of Bremen, Germany: immigrants from Turkey, those from the FSU and the general population.

RESULTS

The SDRs for premature deaths of the two immigrant groups were lower compared to those of the general population. The SMRs remained under 1. Using the indicator of YPLL, we observed higher age-standardised YPLL rates among immigrant populations, particularly among males from the FSU compared to females and population groups 4238/100,000, 95% CI (4119 to 4358). Regarding main causes of premature death, we found larger contributions of infant mortality and diseases of the respiratory system among Turkish immigrants, and of injuries and poisonings, and mental and behavioural disorders among immigrants from the FSU.

CONCLUSIONS

While the overall trends favour the immigrant populations, the indicator of YPLL and cause-specific results indicate areas where the healthcare systems responsiveness may need to be improved, including preventive services. Further work with broader databases providing a similar level of differentiation is necessary to substantiate these findings.

Life Satisfaction Among Ethnic Minorities in Europe

Although life satisfaction (LS) of ethnic minorities can be significantly undermined by several psychological and material hardships, relatively few studies have examined this issue across Europe. The aim of the present study is to examine the impact of belonging to an ethnic minority group on LS, using data from the sixth wave of the European Social Survey (ESS6), carried out in 2012 in 29 countries ( N = 54,540). About 6.7% of all the participants in the ESS6 considered themselves belonging to an ethnic minority group. Our findings show that LS is lower for the ethnic minorities than for the majority not only in the pooled ESS6 sample but also in 19 European countries, most notably in Slovakia and in the Czech Republic. Multilevel analysis indicated that the negative impact of ethnic minority status on LS tended to be enhanced in ex-Communist countries as well as in countries with higher ethnic diversity. The findings of this study show clearly that policy makers of several European countries should focus on increasing social justice and solidarity, and providing ethnic minorities real opportunities to feel more integrated into society.

Applications and limitations of the concept of 'avoidable mortality' among immigrant groups in Europe: a scoping review

OBJECTIVES

Avoidable mortality is often used as a key indicator of broader health inequalities. Health inequalities refer to unfair differences in the quality of health and wellbeing, and health care across different populations. This includes differences in the presence of disease, health outcomes, or access to health care. Migrants represent a disadvantaged and growing demographic with special health risks. This study analyses the usages of the concept of avoidable mortality as applied in studies on migrants in Europe. In doing so, the study aims to identify the strengths and limitations of the concept of avoidable mortality for comparative work.

STUDY DESIGN

A scoping review was conducted for the period of 1990-2011.

METHODS

Publications were identified by a systematic search of PUBMED and WEB OF SCIENCE. An additional five publications were found through the search via references. A total number of 37 publications from 10 European countries were included in the analysis.

RESULTS

The authors divided studies according to direct versus indirect usage of the concept. Studies with direct usage of the concept established a correlation between patterns of avoidable mortality and health care system performance. Additionally, they searched studies which indirectly used avoidable mortality to examine further evidence for the strengths and weaknesses of the concept. These studies used indicators of amenable mortality (at times alongside other mortality indicators) without making direct reference to the concept. Findings using both approaches identified a similar trend in principal causes of premature death. The difference between the two types of studies concerned the more detailed analysis of the causes of death in studies with direct usage categorising into treatable versus preventable causes of death, or health policy versus medical intervention.

CONCLUSIONS

The results of this article highlight the role of health care systems in contributing to migrant health outcomes: whereas mixed outcomes across a number of indicators of avoidable mortality used indirectly do arise, the large number of studies - especially those using the concept directly - evidence a higher share of premature mortality for migrants compared to host populations. These findings can provide policy makers with important insights into targeted ways of improving the access and quality of health services for marginalised populations. However, the strength and depth of such insights stand to improve, as current research on avoidable mortality is often indirect (rather than overt and systematic), thereby limiting the potential for cross-national comparison, as well as a clearer understanding of the links between health outcomes and health care system performance for a disadvantaged group.