Family origin and mortality: prospective Finnish cohort study

Rural-urban and geographical differences in prognosis of atrial fibrillation in Finland: a nationwide cohort study

AIMS

Rural-urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural-urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland.

METHODS

The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural-urban categories and into hospital districts (HDs) based on their municipality of residence.

RESULTS

We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93-1.00) and 0.92 (0.91-0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01-1.08) and 1.06 (1.04-1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28-1.67) and 0.79 (0.62-1.01), and mortality 1.24 (1.16-1.32) and 0.97 (0.93-1.00), respectively.

CONCLUSIONS

Rural-urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs.

Better perceived health among the Swedish-speaking minority as compared with the Finnish-speaking majority in Finland: a cross-sectional study with an intergenerational perspective

BACKGROUND

Previous research has shown that the Swedish speaking minority in Finland has slightly but significantly better health compared with the Finnish speaking majority. However, a clear explanation for this is lacking.

AIM

The aim of the study was to explore differences of perceived health comparing three groups: Swedish speakers with reported dominance of Swedish also in the preceding generation; contemporary Finnish speakers with reported dominance of Finnish in the preceding generation and a group with a reported mixed-language structure of Finnish and Swedish between generations.

INDIVIDUALS AND METHODS

Health and Social Support is an on-going population-based survey initiated in 1998 (N = 64,797), aimed at working-age adults. The present study is based on the 2012 follow-up survey, which included a question on the dominating language (Swedish or Finnish) of the respondents and their parents. The outcome was perceived health, which in this study was dichotomized to very good/good and intermediate/poor/very poor. The statistical analysis was carried with logistic regression, using SAS software. Age, gender and occupational training were included as covariates in the multivariable analysis.

RESULTS

This study found that the Swedish-speaking group in Finland report better perceived health compared with the Finnish-speaking group (odds ratio 1.28, 95% confidence interval 1.04-1.57, p < 0.001). The health of the mixed language-speaking group fell between the other two groups.

CONCLUSIONS

The results gave some support to a culturally mediated mechanism for the health advantage of Swedish speakers. Cultural features of Swedish-speaking groups in Finland may also support health promotion of the Finnish-speaking majority.

Multimorbidity in Finnish and Swedish speaking Finns; association with daily habits and socioeconomic status - Nordic EpiLung cross-sectional study

Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count ≥ 2. Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p = 0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.

Dyspnea has an association with lifestyle: differences between Swedish and Finnish speaking persons in Western Finland

Background Difference in dyspnea mMRC ≥2 between Finnish speaking and Swedish-speaking populations in Finland has not been previously studied.

Methods In February 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20–69 years in western Finland with a response rate of 52.3%. The registered native language of each subject determined whether questionnaire in Finnish or Swedish was applied. Multiple logistic regression was performed to calculate Odds Ratios (OR) with 95% CI for the simultaneous effects of independent variables on dyspnea mMRC ≥2.

Results Of all participants, 2780 (71.9%) were Finnish speakers and 1084 (28.1%) were Swedish speakers. Finnish speakers had a higher prevalence of dyspnea mMRC ≥2 (11.1% vs 6.5% p < 0.001) when compared to Swedish speakers. Finnish speakers smoked more often, had higher BMI, spent less time moving during the day, had more often occupational exposure to vapours, gases, dusts or fumes (VGDF), and had lower socioeconomic status based on occupation. Significant risk factors for dyspnea mMRC ≥2 were COPD (OR = 10.94), BMI >35 (OR = 9.74), asthma (OR = 4.78), female gender (OR = 2.38), older age (OR = 2.20), current smoking (OR = 1.59), and occupational exposure to VGDF (OR = 1.47).

Conclusions Swedish speakers had less dyspnea mMRC ≥2 which is explained by a healthier lifestyle. Smoking, obesity, and occupational exposures should be in focus to improve respiratory health.

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.