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Satokangas M, Arffman M, Agerholm J, Hougaard C, Andersen I, Burström B, Keskimäki I. Geographic and socioeconomic equity in PHC performance among the elderly in three Nordic countries. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Denmark, Finland, and Sweden pursue equity in health for their citizens through universal health care. It is however unclear if these services reach the elderly population equally between different socioeconomic positions (SEP) or living-areas. Our aim was to assess both socioeconomic and geographic equity in primary health care (PHC) performance among the elderly 2000-2015 in the City of Copenhagen, Metropolitan Area of Helsinki, and Stockholm County. Hospitalisations for ambulatory care sensitive conditions (ACSC) was applied as a proxy for PHC performance. Hospitalization data for population aged ≥45 was acquired from the Danish National Patient Register, Finnish Care Register HILMO and patient administrative register from Stockholm County Council. Over time development of geographical variation in ACSC within each metropolis was analysed with Poisson multilevel models. These models were adjusted with individual SEP to distinguish between geographic and socioeconomic disparities. When compared to Stockholm, incidence rate ratios of ACSCs were higher both in Copenhagen (IRR 1.25; CI 95% 1.17-1.35) and in Helsinki (1.39; 1.30-1.49). While the average effect of time slightly decreased in each of the three capital regions (0.97; 0.96-0.98), this decrease was slightly more pronounced in Helsinki than in Stockholm (0.98; 0.97-0.99). Geographic variation in ACSCs seemed the highest both in Copenhagen and in Helsinki. Over time these variations seemed to reduce in Helsinki and in Stockholm, but not in Copenhagen. Adjusting for individual SEP seemed to explain a half of this variance in Helsinki and a third in both Stockholm and Copenhagen - after which over time geographic variation seemed to reduce also in Copenhagen. Geographic disparities in PHC performance among the elderly seem to have narrowed in Finland and in Sweden but remained stable in Denmark. However, in Denmark this seems to rather reflect socioeconomic disparities than stagnant development of PHC.
Key messages
Despite the universal health care in Denmark, Finland and Sweden, there seems to persist both socioeconomic and geographic disparities in PHC performance among their elderly populations. Among the elderly, over time geographic disparities in PHC performance seem to have improved in both Finland and Sweden – but stagnated in Denmark due to the socioeconomic disparities.
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Affiliation(s)
- M Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - M Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Agerholm
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - CØ Hougaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Burström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - I Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Keskimäki I, Satokangas M, Lumme S, Partanen VM, Arffman M, Manderbacka K. Are ambulatory care sensitive conditions a valid indicator for quality of primary health care? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hospitalisations due to ambulatory care sensitive conditions (ACSCs) have been used for assessing access to and quality of primary health care (PHC) in many countries. To assess the validity of ACSCs for assessing PHC performance we carried out a series of studies on regional and sociodemographic variations and time trends in ACSC hospitalisations and related mortality.
Methods
Hospitalisations due to ACSCs in Finland in 1992-2013 came from the national Hospital Discharge Register. The data were linked to population at risk data and individual sociodemographic indicators from Statistics Finland, and subsequently to area indicators of population health and socioeconomics, and health care organisation. Depending on study questions, we analysed ACSCs divided into acute, chronic and vaccine-preventable causes using appropriate statistical methods, such as multilevel Poisson models and trajectory modelling.
Results
We found ACSC hospitalisations to be highly associated to subsequent mortality with 4-10-fold excess 1-year mortality compared to the general population. ACSC hospitalisations showed substantial regional variations which declined over the study period due to decreasing variations in hospitalisations related to chronic ACSCs. The variations were mainly attributed to the hospital district level. In detailed analyses, about a quarter of the variance in ACSC hospitalisations was explained by individual level socioeconomic and health factors. In addition, population health indicators and factors related to hospital care organisation explained up to one third of the variance.
Conclusions
At patient level a hospitalisation due to ACSC is a sentinel event and associated to a high risk of poor health outcomes. However, using ACSC for benchmarking PHC providers should be addressed with caution and differences in sociodemographic factors and (co)morbidity of populations at risk, and regional heath and hospital care arrangements should be taken into account.
Key messages
Variations in hospitalisations due to ambulatory care sensitive conditions may mainly be linked to other factors than access to and quality of primary health care. More research is needed to validate ambulatory care sensitive conditions for use in assessing primary health care.
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Affiliation(s)
- I Keskimäki
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - M Satokangas
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - S Lumme
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - M Arffman
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - K Manderbacka
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
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Satokangas M, Arffman M, Leyland A, Keskimäki I. Individual and area-level factors associated with ambulatory care sensitive conditions in Finland. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional, this study aims to observe if these associations change over time. Finland offers a good possibility for this due to its extensive registers and unexplained over time convergence of geographic variation in ACSC.
Methods
This observational study obtained ACSCs in 2011-2017 from the Finnish Hospital Discharge Register and divided them into subgroups of acute, chronic and vaccine-preventable causes. In these subgroups we analysed geographic variations with a three-level multilevel logistic regression model - individuals, health centre areas (HC) and hospital districts (HD) - and estimated the proportion of the variance at each level explained by individual SEP and comorbidities, as well as both primary care and hospital supply and spatial access at three time points.
Results
In the preliminary results of the baseline geographic variation in total ACSCs in 2011-2013 - the model with age and sex - the variance between HDs was nearly twice that between HCs. Individual SEP and comorbidities explained 46% of the variance between HDs and 29% between HCs; and area-level proportion of ACSC periods in primary care inpatient wards a further 12% and 5%. This evened out the unexplained variance between HDs and HCs.
Conclusions
Geographic variation in ACSCs was more pronounced in hospital districts than in the smaller health centre areas. The excess variance between HDs was explained by individual SEP and health status as well as by use of primary care inpatient wards. Our findings suggest that not only hospital bed supply, but also the national structure of hospital services affects ACSCs. This challenges international ACSC comparisons.
Key messages
Geographic variation in ACSCs concentrated in larger areas with differing population characteristics. The national structure of hospital services, such as use of primary care inpatient wards, affects ACSCs.
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Affiliation(s)
- M Satokangas
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - M Arffman
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - A Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Finland
| | - I Keskimäki
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Hakulinen C, Elovainio M, Arffman M, Lumme S, Pirkola S, Keskimäki I, Manderbacka K, Böckerman P. Mental disorders and long-term labour market outcomes: nationwide cohort study of 2 055 720 individuals. Acta Psychiatr Scand 2019; 140:371-381. [PMID: 31254386 DOI: 10.1111/acps.13067] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the associations between an onset of serious mental disorders before the age of 25 with subsequent employment, income and education outcomes. METHODS Nationwide cohort study including individuals (n = 2 055 720) living in Finland between 1988-2015, who were alive at the end of the year they turned 25. Mental disorder diagnosis between ages 15 and 25 was used as the exposure. The level of education, employment status, annual wage or self-employment earnings, and annual total income between ages 25 and 52 (measurement years 1988-2015) were used as the outcomes. RESULTS All serious mental disorders were associated with increased risk of not being employed and not having any secondary or higher education between ages 25 and 52. The earnings for individuals with serious mental disorders were considerably low, and the annual median total income remained rather stable between ages 25 and 52 for most of the mental disorder groups. CONCLUSIONS Serious mental disorders are associated with low employment rates and poor educational outcomes, leading to a substantial loss of total earnings over the life course.
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Affiliation(s)
- C Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - M Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - M Arffman
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Lumme
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Pirkola
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, Tampere, Finland
| | - I Keskimäki
- National Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - K Manderbacka
- National Institute for Health and Welfare, Helsinki, Finland
| | - P Böckerman
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland.,Labour Institute for Economic Research, Helsinki, Finland.,IZA Institute of Labor Economics, Bonn, Germany
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Arffman M, Manderbacka K, Suvisaari J, Koivunen J, Lumme S, Keskimäki I, Ahlgren-Rimpiläinen A, Pukkala E. The impact of severe mental illness on mortality of lung cancer in Finland in 1990-2014. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Arffman
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Manderbacka
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - J Suvisaari
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - S Lumme
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - I Keskimäki
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - E Pukkala
- Finnish Cancer Registry, Helsinki, Finland
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6
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Lumme S, Arffman M, Manderbacka K, Keskimäki I. Cumulative disadvantage and ambulatory care sensitive conditions in 2009—2013 in Finland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Lumme
- National Institute for Health and Welfare, Helsinki, Finland
| | - M Arffman
- National Institute for Health and Welfare, Helsinki, Finland
| | - K Manderbacka
- National Institute for Health and Welfare, Helsinki, Finland
| | - I Keskimäki
- National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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7
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Satokangas M, Lumme S, Arffman M, Manderbacka K, Keskimäki I. ACSC trajectories for primary health care authorities in Finland in 1996-2013. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Satokangas
- National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - S Lumme
- National Institute for Health and Welfare, Helsinki, Finland
| | - M Arffman
- National Institute for Health and Welfare, Helsinki, Finland
| | - K Manderbacka
- National Institute for Health and Welfare, Helsinki, Finland
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Winell K, Arffman M, Pietilae A, Salomaa V. P4474Regional differences in the incidence of acute coronary syndrome and ischemic stroke in diabetic populations reflect differences in the quality of diabetes care. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Winell
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - M Arffman
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - A Pietilae
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
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But A, Arffman M, Sund R, Haukka J. Comorbidities and mortality in persons with type 1 diabetes: the vantage point of multiple time scales via Bayesian intensity model. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Urpilainen E, Marttila M, Hautakoski A, Arffman M, Sund R, Ilanne-Parikka P, Arima R, Kangaskokko J, Puistola U, Läärä E, Hinkula M. The role of metformin and statins in the incidence of epithelial ovarian cancer in type 2 diabetes: a cohort and nested case-control study. BJOG 2018; 125:1001-1008. [DOI: 10.1111/1471-0528.15151] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/19/2022]
Affiliation(s)
- E Urpilainen
- Department of Obstetrics and Gynaecology; PEDEGO Research Unit; Medical Research Centre Oulu; University of Oulu and University Hospital of Oulu; Oulu Finland
| | - M Marttila
- Children, Adolescents and Families Unit; Department of Welfare; National Institute for Health and Welfare; Oulu Finland
| | - A Hautakoski
- Research Unit of Mathematical Sciences; University of Oulu; Oulu Finland
| | - M Arffman
- Service System Research Unit; National Institute for Health and Welfare; Helsinki Finland
| | - R Sund
- Centre for Research Methods; Department of Social Research; University of Helsinki; Helsinki Finland
- Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - P Ilanne-Parikka
- The Diabetes Centre; Finnish Diabetes Association; Tampere Finland
| | - R Arima
- Department of Obstetrics and Gynaecology; PEDEGO Research Unit; Medical Research Centre Oulu; University of Oulu and University Hospital of Oulu; Oulu Finland
| | - J Kangaskokko
- Department of Pathology; Medical Research Centre Oulu; University of Oulu and University Hospital of Oulu; Oulu Finland
| | - U Puistola
- Department of Obstetrics and Gynaecology; PEDEGO Research Unit; Medical Research Centre Oulu; University of Oulu and University Hospital of Oulu; Oulu Finland
| | - E Läärä
- Research Unit of Mathematical Sciences; University of Oulu; Oulu Finland
| | - M Hinkula
- Department of Obstetrics and Gynaecology; PEDEGO Research Unit; Medical Research Centre Oulu; University of Oulu and University Hospital of Oulu; Oulu Finland
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11
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Arima R, Hautakoski A, Marttila M, Arffman M, Sund R, Ilanne-Parikka P, Kangaskokko J, Hinkula M, Puistola U, Läärä E. Cause-specific mortality in endometrioid endometrial cancer patients with type 2 diabetes using metformin or other types of antidiabetic medication. Gynecol Oncol 2017; 147:678-683. [PMID: 29054569 DOI: 10.1016/j.ygyno.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/07/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022]
Abstract
AIM To obtain further evidence of the association between metformin or other types of antidiabetic medication (ADM) and mortality from endometrial cancer (EC) and other causes of death in patients with endometrioid EC and type 2 diabetes (T2D). MATERIALS AND METHODS A retrospective cohort of women with existing T2D and diagnosed with endometrioid EC from 1998 to 2011, obtained from a nationwide diabetes database (FinDM), were included in the study. Cumulative mortality from EC and that from other causes was described by using the Aalen-Johansen estimator. Cause-specific mortality rates were analyzed by using Cox models, and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were estimated in relation to the use of different forms of ADM during the three-year period preceding EC diagnosis. RESULTS From the FinDM cohort we identified 1215 women diagnosed with endometrioid EC, of whom 19% were metformin users, 12% were users of other types of oral antidiabetic medication, 25% used other types of oral antidiabetic medication plus metformin, 26% used insulin and 14% had no antidiabetic medication. Mortality from EC was not found to be different in women using metformin (HR 0.89, 95% Cl 0.52-1.54) but mortality from other causes was lower (HR 0.52, 95% Cl 0.31-0.88) compared with women using other types of oral ADM. CONCLUSIONS Our findings are inconclusive as to the possible effect of metformin on the prognosis of endometrioid EC in women with T2D. However, use of metformin may reduce mortality from other causes.
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Affiliation(s)
- R Arima
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, P.O. Box 23, FIN-90029 Oulu, Finland.
| | - A Hautakoski
- Children, Adolescents and Families Unit, Department of Welfare, National Institute for Health and Welfare, P.O. Box 310, FIN-90101 Oulu, Finland.
| | - M Marttila
- Children, Adolescents and Families Unit, Department of Welfare, National Institute for Health and Welfare, P.O. Box 310, FIN-90101 Oulu, Finland.
| | - M Arffman
- Service System Research Unit, National Institute for Health and Welfare, P.O. Box 30, FIN-00271 Helsinki, Finland.
| | - R Sund
- Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland. P.O. Box 1627, FIN-70211 Kuopio, Finland.
| | - P Ilanne-Parikka
- Science Center, Tampere University Hospital, Tampere, Finland; The Diabetes Center, Finnish Diabetes Association, FIN-33680 Tampere, Finland.
| | - J Kangaskokko
- Department of Pathology, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, P.O. Box 50, FIN-90029 Oulu, Finland.
| | - M Hinkula
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, P.O. Box 23, FIN-90029 Oulu, Finland.
| | - U Puistola
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, P.O. Box 23, FIN-90029 Oulu, Finland.
| | - E Läärä
- Research Unit of Mathematical Sciences, University of Oulu, P.O. Box 8000, FIN-90014 Oulu, Finland.
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Dundas R, Yates M, Arffman M, Manderbacka K, Lumme S, Keskimäki I, Leyland AH. Trends in contributions to amenable mortality in Finland, Scotland and England, 1992-2013. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Lumme S, Manderbacka K, Arffman M, Lehikoinen M, Keskimäki I. Socioeconomic equity of ambulatory care sensitive conditions in 1996–2010 in Finland. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Westman J, Wahlbeck K, Laursen TM, Gissler M, Nordentoft M, Hällgren J, Arffman M, Ösby U. Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden. Acta Psychiatr Scand 2015; 131:297-306. [PMID: 25243359 PMCID: PMC4402015 DOI: 10.1111/acps.12330] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse mortality and life expectancy in people with alcohol use disorder in Denmark, Finland and Sweden. METHOD A population-based register study including all patients admitted to hospital diagnosed with alcohol use disorder (1,158,486 person-years) from 1987 to 2006 in Denmark, Finland and Sweden. RESULTS Life expectancy was 24-28 years shorter in people with alcohol use disorder than in the general population. From 1987 to 2006, the difference in life expectancy between patients with alcohol use disorder and the general population increased in men (Denmark, 1.8 years; Finland, 2.6 years; Sweden, 1.0 years); in women, the difference in life expectancy increased in Denmark (0.3 years) but decreased in Finland (-0.8 years) and Sweden (-1.8 years). People with alcohol use disorder had higher mortality from all causes of death (mortality rate ratio, 3.0-5.2), all diseases and medical conditions (2.3-4.8), and suicide (9.3-35.9). CONCLUSION People hospitalized with alcohol use disorder have an average life expectancy of 47-53 years (men) and 50-58 years (women) and die 24-28 years earlier than people in the general population.
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Affiliation(s)
- J Westman
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden,Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden
| | - K Wahlbeck
- Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden,THL National Institute for Health and WelfareHelsinki, Finland
| | - T M Laursen
- National Centre for Register-Based Research, Aarhus UniversityAarhus, Denmark
| | - M Gissler
- Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden,THL National Institute for Health and WelfareHelsinki, Finland
| | - M Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health SciencesCopenhagen, Denmark
| | - J Hällgren
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden
| | - M Arffman
- THL National Institute for Health and WelfareHelsinki, Finland
| | - U Ösby
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden,Center for Molecular Medicine, Karolinska InstitutetStockholm, Sweden
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Arffman M, Forssas E, Ruuth I, Keskimäki I, Manderbacka K, Sund R. Changes in multimorbidity among people with diabetes in Finland 1990-2011. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Manderbacka K, Arffman M, Keskimäki I. Are there socioeconomic differences in the outcomes of coronary revascularisations – the case of Finland in 1998-2010. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Vehko T, Arffman M, Manderbacka K, Keskimäki I. Breast cancer among women in Finland by income. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Lehikoinen M, Arffman M, Elovainio M, Manderbacka K, Keskimäki I. Is Helsinki a regular metropolis: what has been the impact of increasing social segregation on avoidable mortality? Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Manderbacka K, Arffman M, Järvelin J, Keskimäki I. Differences in hospital costs between socioeconomic groups in Finland 1998-2010. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Manderbacka K, Arffman M, Lyytikäinen O, Sajantila A, Keskimäki I. What really happened with pneumonia mortality in Finland in 2000-2008?: a cohort study. Epidemiol Infect 2013; 141:800-4. [PMID: 22809739 PMCID: PMC9151903 DOI: 10.1017/s0950268812001562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/25/2012] [Accepted: 06/13/2012] [Indexed: 11/06/2022] Open
Abstract
This cohort study examines trends in pneumonia mortality in Finland and the effects of a WHO recommendation restricting the registering of pneumonia as the underlying cause of death (COD) for several chronic diseases. All cases having pneumonia in any COD fields in 2000-2008 were extracted from the COD statistics. We examined trends in underlying-cause pneumonia mortality where pneumonia was also the immediate COD. Results are presented as age-specific and age-standardized rates. In the study period 2000-2008, there were 90 626 deaths with pneumonia in COD fields, while the underlying-cause pneumonia mortality rate decreased from 32 to 6/100 000 person-years. Immediate-cause pneumonia was less often chosen as underlying-cause towards 2008 suggesting an effect from changing coding practices. Changes in coding practices need to be considered when comparing different countries or time periods in pneumonia mortality.
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Affiliation(s)
- K Manderbacka
- National Institute for Health and Welfare (THL), Helsinki, Finland.
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Talvia S, Räsänen L, Lagström H, Pahkala K, Viikari J, Rönnemaa T, Arffman M, Simell O. Longitudinal trends in consumption of vegetables and fruit in Finnish children in an atherosclerosis prevention study (STRIP). Eur J Clin Nutr 2005; 60:172-80. [PMID: 16234839 DOI: 10.1038/sj.ejcn.1602283] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess prospectively the consumption of fruit and vegetables and its' correlation to the parental consumption in boys and girls taking part in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study). HYPOTHESIS Nutrition counselling focused on cardiovascular health effects vegetable and fruit consumption. DESIGN A prospective, randomised, clinical trial. SUBJECTS Children were recruited to the STRIP study between 1989 and 1992. At the age of 7 months, children were randomised to the intervention (n = 540) or the control group (n = 522) and were followed up until the age of 11 years. INTERVENTION Families in the intervention group have, since randomisation, received biannual individualised dietary counselling aimed at reduction of cardiovascular risk factors, especially saturated fat intake. Food records were used to assess fruit and vegetable consumption of children and parents. RESULTS The percentage of total energy intake provided by fruit and vegetables decreased when the children grew older (P for age <0.001). The 1- to 10-year-old intervention boys consumed more vegetables (mean difference 3.18 g/day; CI 1.48-4.86; P < 0.001) and fruit (mean difference 10.1 g/day; CI 5.28-14.94; P < 0.001) than did the control. Mother's consumption correlated with the consumption of their daughters and sons, whereas father's consumption correlated only with the consumption of their sons. CONCLUSIONS Finnish children taking part in the atherosclerosis prevention study had a remarkably low fruit and vegetable consumption, which furthermore decreased with age. The children's consumption correlated with the parental consumption, except between boys and mothers. A slight intervention effect was present only among boys.
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Affiliation(s)
- S Talvia
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.
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