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Pitkänen J, Junna L, Martikainen P. Adolescent Psychiatric Inpatient Episodes and Subsequent Labor Market Trajectories. J Adolesc Health 2024; 74:1175-1183. [PMID: 38493397 DOI: 10.1016/j.jadohealth.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Adolescents with psychiatric disorders are known to be more often not in education, employment, or training (NEET) in young adulthood than their peers. However, since most of the available evidence is based on cross-sectional measurement of NEET, there is less evidence on the processes underlying these differences in labor market disadvantage. We assessed these processes by examining transitions between NEET and non-NEET states across young adulthood and the differences in these transitions by adolescent psychiatric inpatient treatment. METHODS We used longitudinal register data on all individuals born in Finland in 1980-1984 (N = 315,508) to identify psychiatric inpatient episodes between ages 10 and 19 and NEET between ages 20 and 34. We modeled the transitions between NEET and non-NEET states and the impact of psychiatric disorders on these transitions with multistate models. RESULTS Individuals who had psychiatric inpatient episodes in adolescence started their labor market careers as NEET twice as often as their peers. They were also more likely to transition into NEET states and less likely to transition out of NEET. In total, individuals with a history of psychiatric episodes spent from 1.8 to 6.9 more years as NEET between the ages 20 and 34 than their peers, depending on sex, baseline NEET, and diagnostic group. DISCUSSION Adolescents with severe psychiatric disorders are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures are required both at the start of employment trajectories and during later career stages.
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Affiliation(s)
- Joonas Pitkänen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland.
| | - Liina Junna
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany
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Gueltzow M, Lahtinen H, Bijlsma MJ, Myrskylä M, Martikainen P. Genetic propensity to depression and the role of partnership status. Soc Sci Med 2024; 351:116992. [PMID: 38772210 DOI: 10.1016/j.socscimed.2024.116992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/03/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Social relationships and genetic propensity are known to affect depression risk, but their joint effects are poorly understood. This study examined the association of a polygenic index for depression with time to antidepressant (AD) purchasing and the moderating role of partnership status. We analysed data from 30,192 Finnish individuals who participated in the FINRISK and Health 2000 and 2011 surveys and had register and medication data available. We measured genetic risk with a polygenic index (PGI) for depression. Depression was assessed through antidepressant purchases. We estimated an accelerated failure time model with partnership status as time-varying and different sets of confounder adjustments. The predicted cumulative hazard of antidepressant purchasing varied across PGI and partnership status. At follow-up year 10, being widowed was associated with the largest cumulative hazard of 0.34 (95%CI: 0.28-0.39) in the 80th and 0.20 (95%CI: 0.17-0.23) in the 20th PGI percentile, followed by divorced, single, married and cohabiting. Cohabiting was associated with a cumulative hazard of 0.19 (95%CI: 0.16-0.23) in the 80th and 0.11 (95%CI: 0.1-0.13) in the 20th PGI percentile. We found no evidence for an interaction between the PGI and partnership status. Results were robust to different model specifications, gender stratification, and the choice of PGI. Although antidepressant purchasing correlated with both PGI and partnership status, we found no evidence that partnership status could partially offset or amplify the association between the PGI for depression and antidepressant purchasing incidence.
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Affiliation(s)
- Maria Gueltzow
- Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland.
| | - Hannu Lahtinen
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland; Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland
| | - Maarten J Bijlsma
- Max Planck Institute for Demographic Research, Rostock, Germany; Unit PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, University of Groningen, the Netherlands
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland; Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland; Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland
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Silventoinen K, Lahtinen H, Kilpi F, Morris TT, Davey Smith G, Martikainen P. Socio-economic differences in body mass index: the contribution of genetic factors. Int J Obes (Lond) 2024; 48:741-745. [PMID: 38200145 PMCID: PMC11058309 DOI: 10.1038/s41366-024-01459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Higher mean body mass index (BMI) among lower socioeconomic position (SEP) groups is well established in Western societies, but the influence of genetic factors on these differences is not well characterized. METHODS We analyzed these associations using Finnish health surveys conducted between 1992 and 2017 (N = 33 523; 53% women) with information on measured weight and height, polygenic risk scores of BMI (PGS-BMI) and linked data from administrative registers to measure educational attainment, occupation-based social class and personal income. RESULTS In linear regressions, largest adjusted BMI differences were found between basic and tertiary educated men (1.4 kg/m2, 95% confidence interval [CI] 1.2; 1.6) and women (2.5 kg/m2, 95% CI 2.3; 2.8), and inverse BMI gradients were also found for social class and income. These SEP differences arose partly because mean PGS-BMI was higher and partly because PGS-BMI predicted BMI more strongly in lower SEP groups. The inverse SEP gradients of BMI were steeper in women than in men, but sex differences were not found in the genetic contributions to these differences. CONCLUSIONS Better understanding of the interplay between genes and environment provides insight into the mechanisms explaining SEP differences in BMI.
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Affiliation(s)
- Karri Silventoinen
- University of Helsinki, Faculty of Social Sciences, Population Research Unit, Helsinki, Finland.
| | - Hannu Lahtinen
- University of Helsinki, Faculty of Social Sciences, Population Research Unit, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Fanny Kilpi
- Bristol Medical School, University of Bristol, Population Health Sciences, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Tim T Morris
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - George Davey Smith
- Bristol Medical School, University of Bristol, Population Health Sciences, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Pekka Martikainen
- University of Helsinki, Faculty of Social Sciences, Population Research Unit, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
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Remes H, Einiö E, Korhonen K, Luukkonen J, Martikainen P. Fatherhood timing and men's midlife earnings: A within-family study of Finnish cohorts born in 1938-50. Popul Stud (Camb) 2024:1-17. [PMID: 38651996 DOI: 10.1080/00324728.2024.2331472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/06/2022] [Accepted: 11/08/2023] [Indexed: 04/25/2024]
Abstract
Fathers tend to achieve higher earnings than childless men, but there is limited evidence on the associations between fatherhood timing and men's later earnings. Using a longitudinal census-based sample of Finnish men, including a subsample of brothers, we investigated fatherhood timing and men's midlife earnings using both between- and within-family models. Earnings around age 50 were lower among adolescent and young fathers than for men who became fathers at ages 25-29 or later, but these associations became negligible after accounting for measured confounders and unobserved familial confounding. Overall, our findings highlight the important roles of selection into early childbearing and into childlessness. At the population level, early fatherhood was associated with clear negative distributional shifts in fathers' midlife earnings. However, among all men, any influence of fatherhood timing on men's midlife earnings distribution paled in comparison with that of childlessness.
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Hu Y, Metsä-Simola N, Malmberg S, Martikainen P. Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study. J Epidemiol Community Health 2024; 78:277-283. [PMID: 38320855 DOI: 10.1136/jech-2023-221529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/08/2023] [Accepted: 12/16/2023] [Indexed: 04/12/2024]
Abstract
BACKGROUND Grey divorce and later remarriage have become increasingly common in high-income countries, but previous evidence on their impacts on mental health is scarce. Even less is known about the effects of non-marital separation and re-partnering in later life. METHODS Using Finnish registry data from 1996 to 2018 on 228 644 individuals aged 50-70 in 2000-2014, trajectories of antidepressant (AD) use 4 years before and 4 years after divorce, non-marital separation, bereavement and subsequent re-partnering were examined using individual fixed-effects (FE) linear probability models. RESULTS In adjusted FE models, for both genders AD use increased during the 4 years before divorce (men: 5.00 percentage points (95% CI 4.50 to 5.50); women: 6.96 (95% CI 6.34 to 7.59)), non-marital separation (men: 3.20 (95% CI 2.72 to 3.69); women: 5.98 (95% CI 5.30 to 6.66)) and bereavement (men: 4.53 (95% CI 3.97 to 5.09); women: 5.64 (95% CI 5.25 to 6.04)), with the increase accelerating immediately before the event. AD use gradually declined after union dissolution, after which it stabilised on a persistently higher level compared with pre-dissolution. Re-partnering was only associated with a small and transitory reduction in AD use (0.1-1.5 percentage points). The increases in AD use associated with union dissolution were larger in women than in men, whereas the small reductions in AD use associated with re-partnering were particularly short-lived among women. CONCLUSIONS Our results suggest that union dissolution in later life is associated with large and persistent increases in AD use, whereas the reductions associated with re-partnering are limited both in magnitude and duration.
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Affiliation(s)
- Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Niina Metsä-Simola
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Satu Malmberg
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Mecklenburg-Vorpommern, Germany
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
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Tarkiainen L, Martikainen P, Junna L, Remes H. Contribution of causes of death to changing inequalities in life expectancy by income in Finland, 1997-2020. J Epidemiol Community Health 2024; 78:241-247. [PMID: 38233161 DOI: 10.1136/jech-2023-221705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Socioeconomic inequalities in mortality originate from different causes of death. Alcohol-related and smoking-related deaths are major drivers of mortality inequalities across Europe. In Finland, the turn from widening to narrowing mortality disparities by income in the early 2010s was largely attributable to these causes of death. However, little is known about recent inequalities in life expectancy (LE) and lifespan variation. METHODS We used individual-level total population register-based data with annual information on disposable household income and cause-specific mortality for ages 30-95+, and assessed the contribution of smoking on mortality using the Preston-Glei-Wilmoth method. We calculated trends in LE at age 30 and SD in lifespan by income quintile in 1997-2020 and conducted age and cause-of-death decompositions of changes in LE. RESULTS Disparity in LE and lifespan variation by income increased in 2015-2020, largely attributable to the stagnation of both measures in the lowest income quintile. The LE gap between the extreme quintiles in 2018-2020 was 11.2 (men) and 5.9 (women) years, of which roughly 40% was attributable to alcohol and smoking. However, the recent widening of the gap and the stagnation in LE in the lowest quintile over time were not driven by any specific cause-of-death group. CONCLUSIONS After a decade of narrowing inequalities in LE and lifespan variation in Finland, the gaps between income groups are growing again. Increasing LE disparity and stagnating mortality on the lowest income levels are no longer attributable to smoking and alcohol-related deaths but are more comprehensive, originating from most cause-of-death groups.
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Affiliation(s)
- Lasse Tarkiainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Liina Junna
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
| | - Hanna Remes
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
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Luukkonen J, Moustgaard H, Martikainen P, Remes H. Does having siblings really protect against childhood atopic diseases? A total population and within-family analysis. Eur J Epidemiol 2024; 39:289-298. [PMID: 38316709 PMCID: PMC10995035 DOI: 10.1007/s10654-024-01104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
The association between having older siblings and decreased risk for atopic symptoms is well-established. This has been interpreted as evidence for the microbiota hypothesis, i.e. that increased early-childhood microbial exposure caused by siblings protects from immune hypersensitivities. However, possible confounders of the association have received little attention. We used register data on Finnish cohorts born in 1995-2004 (N = 559,077) to assess medication purchases for atopic diseases: antihistamines, eczema medication, asthma medication and Epinephrine. We modelled the probability of atopic medication purchases at ages 0-15 by birth order controlling for important observed confounders and all unobserved genetic and environmental characteristics shared by siblings in a within-family fixed effects model. We further studied medication purchases among first-borns according to the age difference with younger siblings to assess whether having younger siblings in early childhood is beneficial. Having older siblings was associated with a lower probability of atopic medication purchases. Compared to first-borns, the probability was 10-20% lower among second-borns, 20-40% lower among third-borns, and 30-70% lower among subsequent children, depending on medication type. Confounding accounted for up to 75% of these differences, particularly for asthma and eczema medication, but significant differences by birth order remained across all medication types. Among first-borns, a smaller age difference with younger siblings was related to a lower likelihood of atopic medication use. Our results, based on designs that account for unobserved confounding, show that exposure to siblings in early childhood, protects from atopic diseases, and thus strongly support the microbiota hypothesis.
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Affiliation(s)
- Juha Luukkonen
- Population Research Unit, University of Helsinki, Helsinki, Finland.
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland.
| | - Heta Moustgaard
- Population Research Unit, University of Helsinki, Helsinki, Finland.
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland.
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Helsinki, Finland.
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hanna Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
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Metsä-Simola N, Baranowska-Rataj A, Remes H, Kühn M, Martikainen P. Grandparental support and maternal depression: Do grandparents' characteristics matter more for separating mothers? Popul Stud (Camb) 2024:1-21. [PMID: 38356160 DOI: 10.1080/00324728.2023.2287493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/25/2022] [Accepted: 07/10/2023] [Indexed: 02/16/2024]
Abstract
Grandparental support may protect mothers from depression, particularly mothers who separate and enter single parenthood. Using longitudinal Finnish register data on 116,917 separating and 371,703 non-separating mothers with young children, we examined differences in mothers' antidepressant purchases by grandparental characteristics related to provision of support. Grandparents' younger age (<70 years), employment, and lack of severe health problems predicted a lower probability of maternal depression. Depression was also less common if grandparents lived close to the mother and if the maternal grandparents' union was intact. Differences in maternal depression by grandparental characteristics were larger among separating than among non-separating mothers, particularly during the years before separation. Overall, maternal grandmothers' characteristics appeared to matter most, while the role of paternal grandparents was smaller. The findings suggest that grandparental characteristics associated with increased potential for providing support and decreased need of receiving support predict a lower likelihood of maternal depression, particularly among separating mothers.
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Metsä-Simola N, Heggebø K, Kjaer Urhoj S, Martikainen P, Einiö E, Östergren O. Neurological conditions and subsequent divorce risk in the Nordic countries: the importance of gender and both spouses' education. J Epidemiol Community Health 2024:jech-2023-221328. [PMID: 38355292 DOI: 10.1136/jech-2023-221328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/24/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Prior studies suggest that poor physical health, accompanied by functional disability, is associated with increased divorce risk. However, this association may depend on gender, the socioeconomic resources of the couple, as well as the social policy and social (in)equality context in which the illness is experienced. This study focuses on neurological conditions, which often have substantial functional consequences. METHODS We used longitudinal population-wide register data from the years 2007-2016 (Denmark, Sweden) or 2008-2017 (Finland, Norway) to follow 2 809 209 married couples aged 30-64 for neurological conditions, identified using information on specialised healthcare for diseases of the nervous system and subsequent divorce. Cox regression models were estimated in each country, and meta-analysis used to calculate across-country estimates. RESULTS During the 10-year follow-up period, 22.2% of couples experienced neurological conditions and 12.0% of marriages ended in divorce. In all countries, divorce risk was elevated among couples where at least one spouse had a neurological condition, and especially so if both spouses were ill. The divorce risk was either larger or similar for husband's illness, compared with wife's illness, in all educational categories. For the countries pooled, the weighted average HR was 1.21 (95% CI 1.20 to 1.23) for wives' illness, 1.27 (95% CI 1.25 to 1.29) for husbands' illness and 1.38 (95% CI 1.34 to 1.42) for couples where both spouses were ill. CONCLUSIONS Despite some variation by educational resources and country context, the results suggest that the social consequences of illness are noticeable even in Nordic welfare states, with the husband's illness being at least as important as the wife's.
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Affiliation(s)
- Niina Metsä-Simola
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | | | - Stine Kjaer Urhoj
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Pekka Martikainen
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Elina Einiö
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University & Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
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Suulamo U, Remes H, Tarkiainen L, Murphy M, Martikainen P. Excess winter mortality in Finland, 1971-2019: a register-based study on long-term trends and effect modification by sociodemographic characteristics and pre-existing health conditions. BMJ Open 2024; 14:e079471. [PMID: 38309756 PMCID: PMC10840061 DOI: 10.1136/bmjopen-2023-079471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Excess winter mortality is a well-established phenomenon across the developed world. However, whether individual-level factors increase vulnerability to the effects of winter remains inadequately examined. Our aim was to assess long-term trends in excess winter mortality in Finland and estimate the modifying effect of sociodemographic and health characteristics on the risk of winter death. DESIGN Nationwide register study. SETTING Finland. PARTICIPANTS Population aged 60 years and over, resident in Finland, 1971-2019. OUTCOME MEASURES Age-adjusted winter and non-winter death rates, and winter-to-non-winter rate ratios and relative risks (multiplicative interaction effects between winter and modifying characteristics). RESULTS We found a decreasing trend in the relative winter excess mortality over five decades and a drop in the series around 2000. During 2000-2019, winter mortality rates for men and women were 11% and 14% higher than expected based on non-winter rates. The relative risk of winter death increased with age but did not vary by income. Compared with those living with at least one other person, individuals in institutions had a higher relative risk (1.07, 95% CI 1.05 to 1.08). Most pre-existing health conditions did not predict winter death, but persons with dementia emerged at greater relative risk (1.06, 95% CI 1.04 to 1.07). CONCLUSIONS Although winter mortality seems to affect frail people more strongly-those of advanced age, living in institutions and with dementia-there is an increased risk even beyond the more vulnerable groups. Protection of high-risk groups should be complemented with population-level preventive measures.
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Affiliation(s)
- Ulla Suulamo
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- International Max Planck Research School for Population, Health and Data Science, Rostock, Germany
| | - Hanna Remes
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Lasse Tarkiainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Michael Murphy
- The London School of Economics and Political Science Department of Social Policy, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
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Silventoinen K, Lahtinen H, Korhonen K, Smith GD, Ripatti S, Morris T, Martikainen P. Marital status and genetic liability independently predict coronary heart disease incidence. Scand J Public Health 2024; 52:1-4. [PMID: 36071625 PMCID: PMC10845822 DOI: 10.1177/14034948221119634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
AIMS Married individuals have a lower coronary heart disease (CHD) risk than non-married, but the mechanisms behind this are not fully understood. We analyzed whether genetic liability to CHD may affect these associations. METHODS Marital status, a polygenic score of CHD (PGS-CHD), and other risk factors for CHD were measured from 35,444 participants (53% female) in Finnish population-based surveys conducted between 1992 and 2012. During the register-based follow-up until 2020, there were 2439 fatal and non-fatal incident CHD cases. The data were analyzed using linear and Cox regression models. RESULTS Divorced and cohabiting men and women had a higher genetic risk of CHD than married individuals, but the difference was very small (0.023-0.058 standard deviation of PGS-CHD, p-values 0.011-0.429). Both marital status and PGS-CHD were associated with CHD incidence, but the associations were largely independent. Adjusting for behavioral and metabolic risk factors for CHD explained part of these associations (11-20%). No interaction was found between marital status and PGS-CHD for CHD incidence. CONCLUSIONS We showed minor differences between the marital status categories in PGS-CHD and demonstrated that marital status and genetic liability predicted CHD incidence largely independently. This emphasizes the need to measure multiple risk factors when predicting CHD risk.
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Affiliation(s)
- Karri Silventoinen
- Faculty of Social Sciences, University of Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Finland
| | - Hannu Lahtinen
- Faculty of Social Sciences, University of Helsinki, Finland
| | | | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Samuli Ripatti
- Faculty of Medicine, University of Helsinki, Finland
- Institute for Molecular Medicine Finland, Finland
- Broad Institute of MIT and Harvard, USA
| | - Tim Morris
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Pekka Martikainen
- Faculty of Social Sciences, University of Helsinki, Finland
- Centre for Health Equity Studies, Stockholm University, Sweden
- Max-Planck-Institute for Demographic Research, Germany
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Van Hemelrijck WMJ, Martikainen P, Zengarini N, Costa G, Janssen F. The impact of estimation methods for alcohol-attributable mortality on long-term trends for the general population and by educational level in Finland and Italy (Turin). PLoS One 2023; 18:e0295760. [PMID: 38096271 PMCID: PMC10721192 DOI: 10.1371/journal.pone.0295760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS This paper assesses the impact of estimation methods for general and education-specific trends in alcohol-attributable mortality (AAM), and develops an alternative method that can be used when the data available for study is limited. METHODS We calculated yearly adult (30+) age-standardised and age-specific AAM rates by sex for the general population and by educational level (low, middle, high) in Finland and Turin (Italy) from 1972 to 2017. Furthermore the slope index of inequality and relative inequality index were computed by country and sex. We compared trends, levels, age distributions, and educational inequalities in AAM according to three existing estimation methods: (1) Underlying COD (UCOD), (2) Multiple COD (MCOD) method, and (3) the population attributable fractions (PAF)-method. An alternative method is developed based on the pros and cons of these methods and the outcomes of the comparison. RESULTS The UCOD and MCOD approaches revealed mainly increasing trends in AAM compared to the declining trends according to the PAF approach. These differences are more pronounced when examining AAM trends by educational groups, particularly for Finnish men. Until age 65, age patterns are similar for all methods, and levels nearly identical for MCOD and PAF in Finland. Our novel method assumes a similar trend and age pattern as observed in UCOD, but adjusts its level upwards so that it matches the level of the PAF approach for ages 30-64. Our new method yields levels in-between UCOD and PAF for Turin (Italy), and resembles the MCOD rates in Finland for females. Relative inequalities deviate for the PAF-method (lower levels) compared to other methods, whereas absolute inequalities are generally lower for UCOD than all three methods that combine wholly and partly AAM. CONCLUSIONS The choice of method to estimate AAM affects not only levels, but also general and education-specific trends and inequalities. Our newly developed method constitutes a better alternative for multiple-country studies by educational level than the currently used UCOD-method when the data available for study is limited to underlying causes of death.
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Affiliation(s)
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute(NIDI)-KNAW/University of Groningen, The Hague, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Silventoinen K, Luukkonen J, Myrskylä M, Martikainen P. Birth size, school performance and family social position: a study of 650,000 children. Pediatr Res 2023; 94:2105-2114. [PMID: 37516757 PMCID: PMC10665183 DOI: 10.1038/s41390-023-02757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Low birth weight (BW) is associated with lower cognitive functioning, but less is known of these associations across the full range of the BW distribution and its components. We analyzed how BW, birth length (BL) and birth ponderal index (BPI, kg/m3) are associated with school performance and how childhood family social position modifies these associations. METHODS Medical birth records of all Finnish children born in 1987-1997 were linked to school performance records at 16 years of age (N = 642,425). We used population averaged and within-siblings fixed-effects linear regression models. RESULTS BL showed a linear and BW a curvilinear association with school performance whereas for BPI the association was weak. The strongest association was found for BL explaining 0.08% of the variation in school performance in boys and 0.14% in girls. Demographic, gestational and social factors partly explained these associations. Similar but weaker associations were found within sibships. The association of BL with school performance was stronger at lower levels of family social position. CONCLUSION BL shows a linear association with school performance and can explain more school performance variation than BW. At the population level, BL can offer useful information on intrauterine environmental factors relevant for cognitive performance. IMPACT Birth length is linearly associated with school performance in late adolescence and explains a larger proportion of school performance variation than birth weight. The association between birth length and school performance is stronger in families with lower socio-economic position. At the population level, birth length can offer information on the intrauterine environment relevant for later cognitive performance.
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Affiliation(s)
- Karri Silventoinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- Research Institute of Human Development, Kyoto International Social Welfare Exchange Centre, Kyoto, Japan.
| | - Juha Luukkonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Mikko Myrskylä
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
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14
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Tanskanen AO, Metsä-Simola N, Volotinen L, Danielsbacka M, Martikainen P, Remes H. Maternal psychiatric and somatic illness, and the risk of unintentional injuries in children: variation by type of maternal illness, type of injury and child age. J Epidemiol Community Health 2023:jech-2023-220960. [PMID: 37845023 DOI: 10.1136/jech-2023-220960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/06/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Maternal mental illness appears to increase the risk of unintentional childhood injuries, which are a common cause of morbidity and mortality in early childhood. However, little is known about the variations in this association by type of injury and child's age, and studies on the effects of maternal somatic illness on children's injury risk are scarce. METHODS We used Finnish total population register data from 2000 to 2017 to link 1 369 325 children to their biological mothers and followed them for maternal illness and childhood injuries until the children's sixth birthday. Cox regression models were used to examine the associations between maternal illness and children's injuries by type of illness (neurological, psychiatric and cancer), type of injury (transport injuries, falls, burns, drowning or suffocations, poisonings, exposure to inanimate and animate mechanical forces) and child's age (<1 year-olds, 1-2 year-olds, 3-5 year-olds). RESULTS After adjustment for family structure, maternal age at birth, maternal education, income, child's gender, native language and region of residence, children of unwell mothers showed a higher risk of injuries (HR: 1.21, 95% CI: 1.19 to 1.23). This association was clear for maternal neurological (HR: 1.31, 95% CI: 1.26 to 1.36) and psychiatric illnesses (HR: 1.20, 95% CI: 1.18 to 1.23) but inconsistent for cancer. Maternal illness predicted an increased risk of injury across all age groups. CONCLUSIONS Maternal mental and somatic illness may both increase children's injury risk. Adequate social and parenting support for families with maternal illness may reduce childhood injury.
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Affiliation(s)
- Antti O Tanskanen
- Population Research Institute, Väestöliitto, Helsinki, Finland
- INVEST Research Center, University of Turku, Turku, Finland
| | | | - Lotta Volotinen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Mirkka Danielsbacka
- Population Research Institute, Väestöliitto, Helsinki, Finland
- INVEST Research Center, University of Turku, Turku, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Max Planck - Institute for Demographic Research, Rostock, Germany
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
| | - Hanna Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
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15
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Howe LJ, Rasheed H, Jones PR, Boomsma DI, Evans DM, Giannelis A, Hayward C, Hopper JL, Hughes A, Lahtinen H, Li S, Lind PA, Martin NG, Martikainen P, Medland SE, Morris TT, Nivard MG, Pingault JB, Silventoinen K, Smith JA, Willoughby EA, Wilson JF. Educational attainment, health outcomes and mortality: a within-sibship Mendelian randomization study. Int J Epidemiol 2023; 52:1579-1591. [PMID: 37295953 PMCID: PMC10555788 DOI: 10.1093/ije/dyad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Previous Mendelian randomization (MR) studies using population samples (population MR) have provided evidence for beneficial effects of educational attainment on health outcomes in adulthood. However, estimates from these studies may have been susceptible to bias from population stratification, assortative mating and indirect genetic effects due to unadjusted parental genotypes. MR using genetic association estimates derived from within-sibship models (within-sibship MR) can avoid these potential biases because genetic differences between siblings are due to random segregation at meiosis. METHODS Applying both population and within-sibship MR, we estimated the effects of genetic liability to educational attainment on body mass index (BMI), cigarette smoking, systolic blood pressure (SBP) and all-cause mortality. MR analyses used individual-level data on 72 932 siblings from UK Biobank and the Norwegian HUNT study, and summary-level data from a within-sibship Genome-wide Association Study including >140 000 individuals. RESULTS Both population and within-sibship MR estimates provided evidence that educational attainment decreased BMI, cigarette smoking and SBP. Genetic variant-outcome associations attenuated in the within-sibship model, but genetic variant-educational attainment associations also attenuated to a similar extent. Thus, within-sibship and population MR estimates were largely consistent. The within-sibship MR estimate of education on mortality was imprecise but consistent with a putative effect. CONCLUSIONS These results provide evidence of beneficial individual-level effects of education (or liability to education) on adulthood health, independently of potential demographic and family-level confounders.
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Affiliation(s)
- Laurence J Howe
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Humaira Rasheed
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - Paul R Jones
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dorret I Boomsma
- Department of Biological Psychology, Netherlands Twin Registry, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health (APH) and Amsterdam Reproduction and Development (AR&D)
| | - David M Evans
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, UK
- University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | | | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amanda Hughes
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannu Lahtinen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Penelope A Lind
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicholas G Martin
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Germany
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Sarah E Medland
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Tim T Morris
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michel G Nivard
- Department of Biological Psychology, Netherlands Twin Registry, Vrije Universiteit, Amsterdam, Netherlands
| | - Jean-Baptiste Pingault
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - James F Wilson
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, UK
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16
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Lahtinen H, Korhonen K, Martikainen P, Morris T. Polygenic Prediction of Education and Its Role in the Intergenerational Transmission of Education: Cohort Changes Among Finnish Men and Women Born in 1925-1989. Demography 2023; 60:1523-1547. [PMID: 37728435 DOI: 10.1215/00703370-10963788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 09/21/2023]
Abstract
Major changes in the educational distribution of the population and in institutions over the past century have affected the societal barriers to educational attainment. These changes can possibly result in stronger genetic associations. Using genetically informed, population-representative Finnish surveys linked to administrative registers, we investigated the polygenic associations and intergenerational transmission of education for those born between 1925 and 1989. First, we found that a polygenic index (PGI) designed to capture genetic predisposition to education strongly increased the predictiveness of educational attainment in pre-1950s cohorts, particularly among women. When decomposing the total contribution of PGI across different educational transitions, the transition between the basic and academic secondary tracks was the most important. This transition accounted for 60-80% of the total PGI-education association among most cohorts. The transition between academic secondary and higher tertiary levels increased its contribution across cohorts. Second, for cohorts born between 1955 and 1984, we observed that one eighth of the association between parental and one's own education is explained by the PGI. There was also an increase in the intergenerational correlation of education among these cohorts, which was partly explained by an increasing association between family education of origin and the PGI.
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Affiliation(s)
- Hannu Lahtinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Tim Morris
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
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Östergren O, Cederström A, Korhonen K, Martikainen P. Migrant mortality by duration of residence and co-ethnic density - A register-based study on Finnish migrants in Sweden with matched controls in the origin and the destination. Health Place 2023; 83:103064. [PMID: 37348292 DOI: 10.1016/j.healthplace.2023.103064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
Migrant health depends on factors both at the origin and at the destination. Health-related behaviors established before migration may change at the destination. We compare the mortality rates from alcohol- and smoking-related causes and cardiovascular diseases (CVD) of Finnish migrants in Sweden to matched controls in both Sweden and Finland with similar sociodemographic characteristics. Migrant mortality rates from behavioral risk factors lie in-between the rates of non-migrants in the origin and destination. A longer duration of residence is associated with lower mortality and with mortality patterns more similar to Swedes for men. For women, a longer duration of residence is associated with higher mortality, in particular smoking-related mortality, with no tendency of a gradual convergence. The density of Finnish migrants in the local area is modestly associated with mortality. However, CVD mortality tends to be higher and more similar to the level in Finland for migrants in areas with a higher density of Finnish migrants. The results suggest that behavioral changes can reduce mortality differences between migrants and natives and that this can be either beneficial or detrimental to migrant health.
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Affiliation(s)
- Olof Östergren
- Department of Public Health Sciences, Stockholm University, Sweden; Ageing Research Center, Karolinska Institutet, Sweden.
| | | | | | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Sweden; Population Research Unit, University of Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany
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18
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Bishop L, Almquist YB, Pitkänen J, Martikainen P. Offspring hospitalization for substance use and changes in parental mental health: A Finnish register-based study. Adv Life Course Res 2023; 57:100561. [PMID: 38054862 DOI: 10.1016/j.alcr.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 12/07/2023]
Abstract
Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents' psychotropic medication use trajectories by parental sex and educational attainment before and after a child's alcohol- or narcotics-attributable hospitalization. We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models. Among mothers, the prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents' educational attainment did not modify these trajectories. Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.
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Affiliation(s)
- Lauren Bishop
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany.
| | - Ylva B Almquist
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Max Planck Institute for Demographic Research, 18057 Rostock, Germany
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19
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Kilpi F, Jones HE, Magnus MC, Santorelli G, Højsgaard Schmidt LK, Urhoj SK, Nelson SM, Tuffnell D, French R, Magnus PM, Nybo Andersen AM, Martikainen P, Tilling K, Lawlor DA. Association between perinatal mortality and morbidity and customised and non-customised birthweight centiles in Denmark, Finland, Norway, Wales, and England: comparative, population based, record linkage study. BMJ Med 2023; 2:e000521. [PMID: 37663045 PMCID: PMC10471867 DOI: 10.1136/bmjmed-2023-000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023]
Abstract
Objectives To compare the risk of adverse perinatal outcomes according to infants who are born small for gestational age (SGA; <10th centile) or large for gestational age (LGA; >90th centile), as defined by birthweight centiles that are non-customised (ie, standardised by sex and gestational age only) and customised (by sex, gestational age, maternal weight, height, parity, and ethnic group). Design Comparative, population based, record linkage study with meta-analysis of results. Setting Denmark, Finland, Norway, Wales, and England (city of Bradford), 1986-2019. Participants 2 129 782 infants born at term in birth registries. Main outcome measures Stillbirth, neonatal death, infant death, admission to neonatal intensive care unit, and low Apgar score (<7) at 5 minutes. Results Relative to those infants born average for gestational age (AGA), both SGA and LGA births were at increased risk of all five outcomes, but observed relative risks were similar irrespective of whether non-customised or customised charts were used. For example, for SGA versus AGA births, when non-customised and customised charts were used, relative risks pooled over countries were 3.60 (95% confidence interval 3.29 to 3.93) versus 3.58 (3.02 to 4.24) for stillbirth, 2.83 (2.18 to 3.67) versus 3.32 (2.05 to 5.36) for neonatal death, 2.82 (2.07 to 3.83) versus 3.17 (2.20 to 4.56) for infant death, 1.66 (1.49 to 1.86) versus 1.54 (1.30 to 1.81) for low Apgar score at 5 minutes, and (based on Bradford data only) 1.97 (1.74 to 2.22) versus 1.94 (1.70 to 2.21) for admission to the neonatal intensive care unit. The estimated sensitivity of combined SGA or LGA births to identify the three mortality outcomes ranged from 31% to 34% for non-customised charts and from 34% to 38% for customised charts, with a specificity of 82% and 80% with non-customised and customised charts, respectively. Conclusions These results suggest an increased risk of adverse perinatal outcomes of a similar magnitude among SGA or LGA term infants when customised and non-customised centiles are used. Use of customised charts for SGA/LGA births-over and above use of non-customised charts for SGA/LGA births-is unlikely to provide benefits in terms of identifying term births at risk of these outcomes.
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Affiliation(s)
- Fanny Kilpi
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Christine Magnus
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Stine Kjaer Urhoj
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Scott M Nelson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | | | | | - Per Minor Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Pekka Martikainen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Uusimaa, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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20
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Ellonen N, PitkÄnen J, Aaltonen M, Remes H, Martikainen P. Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study. Scand J Public Health 2023:14034948231180670. [PMID: 37589283 DOI: 10.1177/14034948231180670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
AIMS To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents. METHODS A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender. RESULTS For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years. CONCLUSIONS All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.
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Affiliation(s)
- Noora Ellonen
- Faculty of Social Science, Tampere University, Finland
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Zazueta-Borboa JD, Martikainen P, Aburto JM, Costa G, Peltonen R, Zengarini N, Sizer A, Kunst AE, Janssen F. Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries. J Epidemiol Community Health 2023; 77:421-429. [PMID: 37173136 PMCID: PMC10314064 DOI: 10.1136/jech-2023-220385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982-2008; Finnish women, 1985-2017; and Italian men, 1976-1999) were driven by faster mortality declines among the high-educated aged 65-84, and by mortality increases among the low-educated aged 30-59. The long-term decreases (British men, 1976-2008, and Italian women, 1972-2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30-54. CONCLUSION Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30.
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Affiliation(s)
- Jesus Daniel Zazueta-Borboa
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jose Manuel Aburto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, Southern Denmark University, Odense, Denmark
| | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Riina Peltonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Nicolas Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (Torino), Italy
| | - Alison Sizer
- Department of Information Studies, University College London, London, UK
| | - Anton E Kunst
- Social Medicine, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - Fanny Janssen
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Ruiz M, Hu Y, Martikainen P, Bobak M. Life Course Socioeconomic Position and Cognitive Aging Trajectories: A Cross-National Cohort Study in China and England. Innov Aging 2023; 7:igad064. [PMID: 37746633 PMCID: PMC10516463 DOI: 10.1093/geroni/igad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 09/26/2023] Open
Abstract
Background and Objectives Cross-national research on cognitive aging inequality has largely concentrated on Western countries. It is unclear whether socioeconomic position (SEP) has similar effects on cognitive decline in emerging economies. We compared the association between life course SEP and cognitive function trajectories between China and England, the largest nation under state socialism and one of the oldest capitalist countries. Research Design and Methods This cross-cohort study examined participants aged 50 years and older from the China Health and Retirement Longitudinal Study (n = 12,832) and the English Longitudinal Study of aging (n = 8,875). Cognition z-scores were derived using comparable measures of memory and time orientation on 4 occasions. Life course SEP was self-reported by participants at baseline. Seven- to 8-year trajectories of cognition z-scores were estimated using latent growth curve modeling. Country- and gender-specific associations between childhood/adolescent deprivation, education, material wealth, and home ownership were evaluated in relation to model intercept (baseline level) and linear slope (annual rate of change) of cognition. Results After multivariable adjustment, education was positively associated with the greatest differences in baseline cognition across country and gender. Education was further linked to a slower rate of cognitive decline (z-score units per year); but compared with those with low education, Chinese men (b = 0.032) and women (b = 0.065) with high education had significantly slower declines than English men (b = -0.004) and women (b = 0.010) with high education. Discussion and Implications Despite substantial between-cohort differences in downstream and upstream determinants of dementia, education provided the greatest benefits to cognitive aging in England but particularly in China.
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Affiliation(s)
- Milagros Ruiz
- School of Health and Social Care, University of Essex, Colchester, UK
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yaoyue Hu
- Lab 1, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
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Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Shin JI, Inoue Y, Leinsalu M. Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000-2015: a register-based study. BMC Public Health 2023; 23:1103. [PMID: 37286978 DOI: 10.1186/s12889-023-15999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/07/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Drowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000-2015. METHODS Data for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65-W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30-74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality. RESULTS Drowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000-2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000-2015. CONCLUSION Despite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000-2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.
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Affiliation(s)
- Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, 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
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun- gu, Seoul, Korea
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden.
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
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Sariaslan A, Larsson H, Hawton K, Pitkänen J, Lichtenstein P, Martikainen P, Fazel S. Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder. BMJ Ment Health 2023; 26:e300758. [PMID: 37380367 PMCID: PMC10577735 DOI: 10.1136/bmjment-2023-300758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. METHODS By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments. FINDINGS A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals. CONCLUSIONS Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. CLINICAL IMPLICATIONS Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- International Max Planck Research School for Population Health and Data Science, Rostock, Germany
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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25
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Silventoinen K, Lahtinen H, Davey Smith G, Morris TT, Martikainen P. Height, social position and coronary heart disease incidence: the contribution of genetic and environmental factors. J Epidemiol Community Health 2023; 77:384-390. [PMID: 36963814 DOI: 10.1136/jech-2022-219907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The associations between height, socioeconomic position (SEP) and coronary heart disease (CHD) incidence are well established, but the contribution of genetic factors to these associations is still poorly understood. We used a polygenic score (PGS) for height to shed light on these associations. METHODS Finnish population-based health surveys in 1992-2011 (response rates 65-93%) were linked to population registers providing information on SEP and CHD incidence up to 2019. The participants (N=29 996; 54% women) were aged 25-75 at baseline, and there were 1767 CHD incident cases (32% in women) during 472 973 person years of follow-up. PGS-height was calculated based on 33 938 single-nucleotide polymorphisms, and residual height was defined as the residual of height after adjusting for PGS-height in a linear regression model. HRs of CHD incidence were calculated using Cox regression. RESULTS PGS-height and residual height showed clear gradients for education, social class and income, with a larger association for residual height. Residual height also showed larger associations with CHD incidence (HRs per 1 SD 0.94 in men and 0.87 in women) than PGS-height (HRs per 1 SD 0.99 and 0.97, respectively). Only a small proportion of the associations between SEP and CHD incidence was statistically explained by the height indicators (6% or less). CONCLUSIONS Residual height associations with SEP and CHD incidence were larger than for PGS-height. This supports the role of material and social living conditions in childhood as contributing factors to the association of height with both SEP and CHD risk.
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Affiliation(s)
- Karri Silventoinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Lahtinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - George Davey Smith
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Tim T Morris
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden
- Max-Planck-Institute for Demographic Research, Rostock, Germany
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26
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Liu C, Grotta A, Hiyoshi A, Berg L, Wall-Wieler E, Martikainen P, Kawachi I, Rostila M. Parental death and initiation of antidepressant treatment in surviving children and youth: a national register-based matched cohort study. EClinicalMedicine 2023; 60:102032. [PMID: 37396801 PMCID: PMC10314171 DOI: 10.1016/j.eclinm.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Population-based longitudinal studies on bereaved children and youth's mental health care use are scarce and few have assessed the role of surviving parents' mental health status. Methods Using register data of individuals born in Sweden in 1992-1999, we performed a matched cohort study (n = 117,518) on the association between parental death and subsequent initiation of antidepressant treatment among individuals bereaved at ages 7-24 years. We used flexible parametric survival models to estimate the hazard ratios (HRs) over time after bereavement, adjusting for individual and parental factors. We further examined if the association varied by age at loss, sex, parental sociodemographic factors, cause of death, and the surviving parents' psychiatric care. Findings The bereaved were more likely to initiate antidepressants treatment than the nonbereaved matched individuals during follow-up (incidence rate per 1000 person years 27.5 [26.5-28.5] vs. 18.2 [17.9-18.6]). The HRs peaked in the first year after bereavement and remained higher than the nonbereaved individuals until the end of the follow-up. The average HR over the 12 years of follow-up was 1.48 (95% confidence interval [1.39-1.58]) for father's death and 1.33 [1.22-1.46] for mother's death. The HRs were particularly high when the surviving parents received psychiatric care before bereavement (2.11 [1.89-2.56] for father's death; 2.14 [1.79-2.56] for mother's death) or treated for anxiety or depression after bereavement (1.80 [1.67-1.94]; 1.82 [1.59-2.07]). Interpretation The risk of initiating antidepressant treatment was the highest in the first year after parental death and remained elevated over the next decade. The risk was particularly high among individuals with surviving parents affected by psychiatric morbidity. Funding The Swedish Research Council.
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Affiliation(s)
- Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Ayako Hiyoshi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | | | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Germany
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, United States
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
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27
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Guzman-Castillo M, Korhonen K, Murphy M, Martikainen P. Projections of future burden of pharmacologically treated type 2 diabetes and associated life expectancies by income in Finland: a multi-state modeling study. Front Public Health 2023; 11:1141452. [PMID: 37304089 PMCID: PMC10250626 DOI: 10.3389/fpubh.2023.1141452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
The burden of type 2 diabetes (T2D) differs between socioeconomic groups. The present study combines ongoing and plausible trends in T2D incidence and survival by income to forecast future trends in cases of T2D and life expectancy with and without T2D up to year 2040. Using Finnish total population data for those aged 30 years on T2D medication and mortality in 1995-2018, we developed and validated a multi-state life table model using age-, gender-, income- and calendar year-specific transition probabilities. We present scenarios based on constant and declining T2D incidence and on the effect of increasing and decreasing obesity on T2D incidence and mortality states up to 2040. With constant T2D incidence at 2019-level, the number of people living with T2D would increase by about 26% between 2020 and 2040. The lowest income group could expect more rapid increases in the number with T2D compared to the highest income group (30% vs. 23% respectively). If the incidence of T2D continues the recent declining trend, we predict about 14% fewer cases. However, if obesity increases two-fold, we predict 15% additional T2D cases. Unless, we reduce the obesity-related excess risk, the number of years lived without T2D could decrease up to 6 years for men in the lowest income group. Under all plausible scenarios, the burden of T2D is set to increase and it will be unequally distributed among socioeconomic groups. An increasing proportion of life expectancy will be spent with T2D.
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Affiliation(s)
- Maria Guzman-Castillo
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Luukkonen J, Tarkiainen L, Martikainen P, Remes H. Minimum legal drinking age and alcohol-attributable morbidity and mortality by age 63 years: a register-based cohort study based on alcohol reform. Lancet Public Health 2023; 8:e339-e346. [PMID: 37120258 DOI: 10.1016/s2468-2667(23)00049-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Minimum legal drinking age (MLDA) is an effective policy tool in preventing youth drinking and short-term alcohol-attributable harm, but studies concerning long-term associations are scarce. METHODS In this register-based, national cohort study, we assessed alcohol-attributable morbidity and mortality of cohorts born in 1944-54 in Finland. Data were from the 1970 census, the Care Register for Healthcare (maintained by the Finnish Institute of Health and Welfare), and the Cause-of-Death Register (maintained by Statistics Finland). As MLDA was lowered from 21 years to 18 years in 1969, these cohorts were effectively allowed to buy alcohol from different ages (18-21 years). We used survival analysis to compare their alcohol-attributable mortality and hospitalisations with a 36-year follow-up. FINDINGS Compared with the first cohort (1951) allowed to buy alcohol from age 18, the hazard ratios (HRs) for alcohol-attributable morbidity and mortality were lower in cohorts who could not buy alcohol until age 20 or 21 years. For alcohol-attributable morbidity in those aged 21 years when the reform took place, HR was 0·89 (95% CI 0·86-0·93) for men and 0·87 (0·81-0·94) for women versus those aged 17 years. For alcohol-attributable mortality, HR was 0·86 (0·79-0·93) for men and 0·78 (0·66-0·92) for women aged 21 years when the reform took place. The outcomes of the later-born 1952-54 cohorts did not differ from the 1951 cohort. INTERPRETATION Earlier cohorts had consistently lower alcohol-attributable mortality and morbidity; however, other simultaneous increases in alcohol availability probably contributed to increased alcohol-related harm among the younger cohorts. Overall, differences between cohorts born only a few years apart highlight late adolescence as a crucial period for the establishment of lifelong patterns of alcohol use and suggest that higher MLDA could be protective for health beyond young adulthood. FUNDING Yrjö Jahnsson Foundation, Foundation for Economic Education, Emil Aaltonen Foundation, Academy of Finland, European Research Council, and NordForsk.
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Affiliation(s)
- Juha Luukkonen
- Population Research Unit, University of Helsinki, Helsinki, Finland.
| | - Lasse Tarkiainen
- Population Research Unit, University of Helsinki, Helsinki, Finland; Helsinki Institute of Urban and Regional Studies, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Hanna Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
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29
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Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Shin JI, Oh H, Waldman K, Leinsalu M. Educational inequalities in hypothermia mortality in the Baltic countries and Finland in 2000-15. Eur J Public Health 2023:7140394. [PMID: 37094965 PMCID: PMC10393481 DOI: 10.1093/eurpub/ckad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Despite an increased focus on cold-related mortality in recent years, there has been comparatively little research specifically on hypothermia mortality and its associated factors. METHODS Educational inequalities in hypothermia mortality among individuals aged 30-74 in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in 2000-15 were examined using data from longitudinal mortality follow-up studies of population censuses (the Baltics) and from a longitudinal register-based population data file (Finland). RESULTS Age-standardized mortality rates (ASMRs) were much higher in the Baltic countries than in Finland across the study period. From 2000-07 to 2008-15, overall ASMRs declined in all countries except among Finnish women. Although a strong educational gradient was observed in hypothermia mortality in all countries in 2000-07, inequalities were larger in the Baltic countries. Between 2000-07 and 2008-15, ASMRs declined in all educational groups except for high-educated women in Finland and low-educated women in Lithuania; the changes however were not always statistically significant. The absolute mortality decline was often larger among the low educated resulting in narrowing absolute inequalities (excepting Lithuania), whereas a larger relative decline among the high educated (excepting Finnish women) resulted in a considerable widening of relative inequalities in hypothermia mortality by 2008-15. CONCLUSION Although some reduction was observed in absolute educational inequalities in hypothermia mortality in 2000-15, substantial and widening relative inequalities highlight the need for further action in combatting factors behind deaths from excessive cold in socioeconomically disadvantaged groups, including risky alcohol consumption and homelessness.
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Affiliation(s)
- Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, 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
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Kyle Waldman
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - 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
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Long D, Mackenbach JP, Klokgieters S, Kalėdienė R, Deboosere P, Martikainen P, Heggebø K, Leinsalu M, Bopp M, Brønnum-Hansen H, Costa G, Eikemo T, Nusselder WJ. Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries. J Epidemiol Community Health 2023; 77:400-408. [PMID: 37094941 PMCID: PMC10176379 DOI: 10.1136/jech-2023-220342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Silvia Klokgieters
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Heggebø
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- NOVA, Oslo Metropolitan University, Oslo, Norway
| | - 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
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | - Terje Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Yao H, Junna L, Hu Y, Sha X, Martikainen P. The relationship of income on stroke incidence in Finland and China. Eur J Public Health 2023:7136716. [PMID: 37087112 DOI: 10.1093/eurpub/ckad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. METHODS Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. RESULTS The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576-0.696] and HR 0.572 (95% CI 0.540-0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276-0.739) and HR 0.633 (95% CI 0.406-0.708) for China. CONCLUSIONS Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.
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Affiliation(s)
- Honghui Yao
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, ChangdeXiangya Hospital, Central South University, Hunan, China
| | - Liina Junna
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Rostock, Germany
| | - Yaoyue Hu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinping Sha
- Department of Infectious Diseases, ChangdeXiangya Hospital, Central South University, Hunan, China
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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32
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Sariaslan A, Fanshawe T, Pitkänen J, Cipriani A, Martikainen P, Fazel S. Predicting suicide risk in 137,112 people with severe mental illness in Finland: external validation of the Oxford Mental Illness and Suicide tool (OxMIS). Transl Psychiatry 2023; 13:126. [PMID: 37072392 PMCID: PMC10113231 DOI: 10.1038/s41398-023-02422-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Oxford Mental Illness and Suicide tool (OxMIS) is a standardised, scalable, and transparent instrument for suicide risk assessment in people with severe mental illness (SMI) based on 17 sociodemographic, criminal history, familial, and clinical risk factors. However, alongside most prediction models in psychiatry, external validations are currently lacking. We utilised a Finnish population sample of all persons diagnosed by mental health services with SMI (schizophrenia-spectrum and bipolar disorders) between 1996 and 2017 (n = 137,112). To evaluate the performance of OxMIS, we initially calculated the predicted 12-month suicide risk for each individual by weighting risk factors by effect sizes reported in the original OxMIS prediction model and converted to a probability. This probability was then used to assess the discrimination and calibration of the OxMIS model in this external sample. Within a year of assessment, 1.1% of people with SMI (n = 1475) had died by suicide. The overall discrimination of the tool was good, with an area under the curve of 0.70 (95% confidence interval: 0.69-0.71). The model initially overestimated suicide risks in those with elevated predicted risks of >5% over 12 months (Harrell's Emax = 0.114), which applied to 1.3% (n = 1780) of the cohort. However, when we used a 5% maximum predicted suicide risk threshold as is recommended clinically, the calibration was excellent (ICI = 0.002; Emax = 0.005). Validating clinical prediction tools using routinely collected data can address research gaps in prediction psychiatry and is a necessary step to translating such models into clinical practice.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Moderating role of sociodemographic factors in parental psychiatric treatment before and after offspring severe self-harm. J Affect Disord 2023; 327:145-154. [PMID: 36758868 DOI: 10.1016/j.jad.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 03/24/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Parental psychiatric disorders are known risk factors for adolescent self-harm. Although this association is likely to have a bidirectional element, evidence on changes in parental psychiatric treatment following offspring self-harm is scarce. METHODS Finnish children born in 1987-1996 with a hospital-treated episode of self-harm between the ages 13 and 19 years (N = 3636) were identified using administrative register data, and their biological mothers (N = 3432) and fathers (N = 3167) were followed two years before and after the episode. Data on purchases of psychotropic medication, specialized psychiatric treatment and psychiatric sickness allowances were used to examine psychiatric treatment among parents. Differences by parental education, employment and living arrangements were assessed, and offspring self-harm was compared with offspring accidental poisonings and traffic accidents. RESULTS Psychiatric treatment peaked among mothers during the three-month period after offspring self-harm, after which the treatment prevalence decreased but remained slightly elevated relative to the time preceding offspring self-harm. Higher levels of education and being employed increased the likelihood of treatment right after the episode. Among fathers, changes in treatment were negligible. Treatment trajectories around the comparison events of accidents were similar in shape but more muted than among the parents whose children had self-harmed. LIMITATIONS General practitioner visits or other data from primary health care were not available. CONCLUSION Mothers receive increased psychiatric treatment after stressful offspring events. Our results indicate that prevention of self-harm and accidents would be beneficial not only for those directly concerned but also for their family members.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health Sciences, Stockholm University, Sweden
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34
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Remes H, Palma Carvajal M, Peltonen R, Martikainen P, Goisis A. Correction: The Well-Being of Adolescents Conceived Through Medically Assisted Reproduction: A Population-Level and Within-Family Analysis. Eur J Popul 2023; 39:12. [PMID: 38153626 PMCID: PMC10090244 DOI: 10.1007/s10680-023-09663-6] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014, Helsinki, Finland.
| | | | - Riina Peltonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014, Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Alice Goisis
- University College London, Social Research Institute, London, UK
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35
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Goisis A, Cederström A, Martikainen P. Birth Outcomes Following Assisted Reproductive Technology Conception Among Same-Sex Lesbian Couples vs Natural Conception and Assisted Reproductive Technology Conception Among Heterosexual Couples. JAMA 2023; 329:1117-1119. [PMID: 37014346 PMCID: PMC10074214 DOI: 10.1001/jama.2023.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 04/05/2023]
Abstract
This study uses registry data to compare birth outcomes, including birth weight, gestational age, low birth weight, and preterm delivery, in assisted reproductive technology (ART) pregnancies among same-sex lesbian couples vs natural conceptions and ART pregnancies among heterosexual couples.
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Affiliation(s)
- Alice Goisis
- Centre for Longitudinal Studies, University College London, London, England
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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36
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Lahtinen H, Moustgaard H, Ripatti S, Martikainen P. Association between genetic risk of alcohol consumption and alcohol-related morbidity and mortality under different alcohol policy conditions: Evidence from the Finnish alcohol price reduction of 2004. Addiction 2023; 118:678-685. [PMID: 36564914 DOI: 10.1111/add.16118] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/28/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
AIMS Harmful alcohol consumption is influenced by both genetic susceptibility and the price of alcohol. Many previous studies have observed that genetic susceptibility to consumption of alcohol is more predictive in less restrictive drinking conditions. We assess whether such a pattern applies when the prices of alcoholic beverages are decreased. DESIGN Data consist of genetically informed population-representative surveys (FINRISK 1992, 1997, 2002 and Health 2000) linked to administrative registers. We analysed the interaction between a polygenic score (PGS) for alcoholic drinks per week consumed and price reduction in predicting the incidence of alcohol-related hospitalizations and deaths in difference-in-difference and interrupted time-series frameworks. SETTING Individuals in Finland were followed quarter-yearly from 1 March 2000 to 31 May 2008. PARTICIPANTS A total of 22 152 individuals (607 132-person quarter-years, 1399 outcome events) aged 30-79 years. INTERVENTION A natural experiment stemming from the alcohol tax reduction in March 2004 and import deregulation in May 2004. MEASUREMENTS Outcome was quarter-yearly-measured alcohol-related death or hospitalization. The independent variables of main interest were PGS and a price reform indicator. We adjusted for gender, age, age squared, season, 10 first principal components of the genome, data collection round and genotyping batch. FINDINGS Both alcohol price reduction and one standard deviation change in PGS were associated with alcohol-related health outcomes; odds ratios (ORs) were 1.32, 95% confidence interval (CI) = 1.13, 1.53 and 1.26, 95% CI = 1.12, 1.42 in the 8-year follow-up, respectively. The association between PGS and alcohol-related morbidity was similar before and after the alcohol price reform (PGS × price reform interaction OR = 0.96, 95% CI = 0.81, 1.14). These results were robust across different follow-up periods and measurement and analysis strategies. CONCLUSIONS Although the decrease of alcohol price in Finland in 2004 substantially increased overall alcohol-related morbidity and mortality, the genetic susceptibility to alcohol consumption did not become more manifest in predicting them.
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Affiliation(s)
- Hannu Lahtinen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany
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37
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Mcminn MA, Martikainen P, Härkänen T, Tolonen H, Pitkänen J, Leyland AH, Gray L. Adjustment for survey non-participation using record linkage and multiple imputation: A validity assessment exercise using the Health 2000 survey. Scand J Public Health 2023; 51:215-224. [PMID: 34396808 PMCID: PMC7614246 DOI: 10.1177/14034948211031383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022]
Abstract
AIMS It is becoming increasingly possible to obtain additional information about health survey participants, though not usually non-participants, via record linkage. We aimed to assess the validity of an assumption underpinning a method developed to mitigate non-participation bias. We use a survey in Finland where it is possible to link both participants and non-participants to administrative registers. Survey-derived alcohol consumption is used as the exemplar outcome. METHODS Data on participants (85.5%) and true non-participants of the Finnish Health 2000 survey (invited survey sample N=7167 aged 30-79 years) and a contemporaneous register-based population sample (N=496,079) were individually linked to alcohol-related hospitalisation and death records. Applying the methodology to create synthetic observations on non-participants, we created 'inferred samples' (participants and inferred non-participants). Relative differences (RDs) between the inferred sample and the invited survey sample were estimated overall and by education. Five per cent limits were used to define acceptable RDs. RESULTS Average weekly consumption estimates for men were 129 g and 131 g of alcohol in inferred and invited survey samples, respectively (RD -1.6%; 95% confidence interval (CI) -2.2 to -0.04%) and 35 g for women in both samples (RD -1.1%; 95% CI -2.4 to -0.8%). Estimates for men with secondary levels of education had the greatest RD (-2.4%; 95% CI -3.7 to -1.1%). CONCLUSIONS The sufficiently small RDs between inferred and invited survey samples support the assumption validity and use of our methodology for adjusting for non-participation. However, the presence of some significant differences means caution is required.
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Affiliation(s)
- Megan A. Mcminn
- MRC/CSO Social and Public Health
Sciences Unit, University of Glasgow, UK
- Usher Institute, University of
Edinburgh, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of
Social Sciences, University of Helsinki, Finland
| | - Tommi Härkänen
- Public Health and Welfare, National
Institute for Health and Welfare (THL), Finland
| | - Hanna Tolonen
- Public Health and Welfare, National
Institute for Health and Welfare (THL), Finland
| | - Joonas Pitkänen
- Population Research Unit, Faculty of
Social Sciences, University of Helsinki, Finland
| | | | - Linsay Gray
- MRC/CSO Social and Public Health
Sciences Unit, University of Glasgow, UK
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38
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Abstract
The study of the mortality differences between groups has traditionally focused on metrics that describe average levels of mortality, for example life expectancy and standardized mortality rates. Additional insights can be gained by using statistical distance metrics to examine differences in lifespan distributions between groups. Here, we use a distance metric, the non-overlap index, to capture the sociological concept of stratification, which emphasizes the emergence of unique, hierarchically layered social strata. We show an application using Finnish registration data that cover the entire population over the period from 1996 to 2017. The results indicate that lifespan stratification and life-expectancy differences between income groups both increased substantially from 1996 to 2008; subsequently, life-expectancy differences declined, whereas stratification stagnated for men and increased for women. We conclude that the non-overlap index uncovers a unique domain of inequalities in mortality and helps to capture important between-group differences that conventional approaches miss.
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Affiliation(s)
- Jiaxin Shi
- Max Planck Institute for Demographic Research.,University of Oxford
| | | | - Pekka Martikainen
- Max Planck Institute for Demographic Research.,University of Helsinki.,Stockholm University
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39
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Luukkonen J, Junna L, Remes H, Martikainen P. The association of lowered alcohol prices with birth outcomes and abortions: A population-based natural experiment. Addiction 2023; 118:836-844. [PMID: 36791778 DOI: 10.1111/add.16119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 04/28/2022] [Accepted: 12/05/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND AIMS Alcohol use during pregnancy remains an important risk factor for adverse birth outcomes, but little is known regarding how alcohol prices affect pregnancy outcomes on the population level. We assess the associations between decreased alcohol prices with birth outcomes and abortions. DESIGN Using national registers, we used interrupted time-series modelling to compare outcomes of pregnancies conceived before and after a tax cut, resulting in 33% mean decrease of off-premise alcohol prices on 1 March 2004. We also addressed possible heterogeneity of the associations by maternal age and household income. SETTING Finland. PARTICIPANTS All registered pregnancies starting 2 years before and 1 year after the alcohol price cut (analysis sample consisted of 169 735 live births and 32 441 abortions). MEASUREMENTS The outcomes were birth weight, gestational age, the probability of low birth weight (< 2500 g at birth), preterm birth (< 37 weeks of gestation), any congenital malformations and share of registered abortions of pregnancies. FINDINGS On the population level, lowered alcohol prices were associated with an increase in abortions immediately after the price cut [+0.84 percentage points; 95% confidence interval (CI) = 0.2, 1.4]. For birth outcomes, negative associations were observed among women in the lowest income quintile; for example, increased probabilities of low birth weight (+1.5 percentage points; 95% CI = 0.4, 2.6) and preterm birth (+1.98 percentage points; 95% CI = 0.8, 3.2). All changes were strongest immediately after the price cut and attenuated during the course of the following year. CONCLUSIONS Lowered alcohol prices in Finland were associated with a short-term increase in adverse birth outcomes among low-income mothers and an overall increase in abortions.
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Affiliation(s)
- Juha Luukkonen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Liina Junna
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hanna Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Public Health Sciences, University of Stockholm, Stockholm, Sweden
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40
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Knop J, Martikainen P, Remes H, Tarkiainen L. Income differences in partial life expectancy between ages 35 and 64 from 1988 to 2017: the contribution of living arrangements. Eur J Public Health 2023; 33:13-19. [PMID: 36377975 DOI: 10.1093/eurpub/ckac159] [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: 11/16/2022] Open
Abstract
BACKGROUND Socioeconomic differences in mortality among the working-age population have increased in several high-income countries. The aim of this study was to assess whether changes in the living arrangement composition of income groups have contributed to changing income differences in life expectancy during the past 30 years. METHODS We used Finnish register data covering the total population to calculate partial life expectancies between ages 35 and 64 by income quartile in 1988-2017. The contribution of living arrangements to these differences was assessed by direct standardization. Decomposition methods were used to determine the extent of life expectancy differences due to external (accidental, violent and alcohol-related) causes of death. RESULTS The life expectancy gap between the highest and lowest income quartile increased until 2003-07, but decreased thereafter. The contribution of living arrangements to these differences remained mostly stable: 36-39% among men and 15-23% among women. Those living without children consistently showed the greatest life expectancy differences by income. External causes of death significantly contributed to income differences in life expectancy. CONCLUSIONS The living arrangement composition of income groups explained part of the differences in life expectancy, but not their changes. Our results on the contribution of external causes of death imply that both the persistent income gradient in mortality as well as the mortality disparities by living arrangements are at least partially related to similar selection or causal mechanisms.
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Affiliation(s)
- Jade Knop
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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41
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Vaccarella S, Georges D, Bray F, Ginsburg O, Charvat H, Martikainen P, Brønnum-Hansen H, Deboosere P, Bopp M, Leinsalu M, Artnik B, Lorenzoni V, De Vries E, Marmot M, Vineis P, Mackenbach J, Nusselder W. Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study. Lancet Reg Health Eur 2023; 25:100551. [PMID: 36818237 PMCID: PMC9929598 DOI: 10.1016/j.lanepe.2022.100551] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
Background Reducing socioeconomic inequalities in cancer is a priority for the public health agenda. A systematic assessment and benchmarking of socioeconomic inequalities in cancer across many countries and over time in Europe is not yet available. Methods Census-linked, whole-of-population cancer-specific mortality data by socioeconomic position, as measured by education level, and sex were collected, harmonized, analysed, and compared across 18 countries during 1990-2015, in adults aged 40-79. We computed absolute and relative educational inequalities; temporal trends using estimated-annual-percentage-changes; the share of cancer mortality linked to educational inequalities. Findings Everywhere in Europe, lower-educated individuals have higher mortality rates for nearly all cancer-types relative to their more highly-educated counterparts, particularly for tobacco/infection-related cancers [relative risk of lung cancer mortality for lower- versus higher-educated = 2.4 (95% confidence intervals: 2.1-2.8) among men; = 1.8 (95% confidence intervals: 1.5-2.1) among women]. However, the magnitude of inequalities varies greatly by country and over time, predominantly due to differences in cancer mortality among lower-educated groups, as for many cancer-types higher-educated have more similar (and lower) rates, irrespective of the country. Inequalities were generally greater in Baltic/Central/East-Europe and smaller in South-Europe, although among women large and rising inequalities were found in North-Europe (relative risk of all cancer mortality for lower- versus higher-educated ≥1.4 in Denmark, Norway, Sweden, Finland and the England/Wales). Among men, rate differences (per 100,000 person-years) in total-cancer mortality for lower-vs-higher-educated groups ranged from 110 (Sweden) to 559 (Czech Republic); among women from approximately null (Slovenia, Italy, Spain) to 176 (Denmark). Lung cancer was the largest contributor to inequalities in total-cancer mortality (between-country range: men, 29-61%; women, 10-56%). 32% of cancer deaths in men and 16% in women (but up to 46% and 24%, respectively in Baltic/Central/East-Europe) were associated with educational inequalities. Interpretation Cancer mortality in Europe is largely driven by levels and trends of cancer mortality rates in lower-education groups. Even Nordic-countries, with a long-established tradition of equitable welfare and social justice policies, witness increases in cancer inequalities among women. These results call for a systematic measurement, monitoring and action upon the remarkable socioeconomic inequalities in cancer existing in Europe. Funding This study was done as part of the LIFEPATH project, which has received financial support from the European Commission (Horizon 2020 grant number 633666), and the DEMETRIQ project, which received support from the European Commission (grant numbers FP7-CP-FP and 278511). SV and WN were supported by the French Institut National du Cancer (INCa) (Grant number 2018-116). PM was supported by the Academy of Finland (#308247, # 345219) and the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No 101019329). The work by Mall Leinsalu was supported by the Estonian Research Council (grant PRG722).
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Affiliation(s)
- Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Damien Georges
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Ophira Ginsburg
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
- Center for Global Health, U.S. National Cancer Institute Maryland, USA
| | - Hadrien Charvat
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Henrik Brønnum-Hansen
- Section for Social Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Deboosere
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, 141 89, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Barbara Artnik
- Chair of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Esther De Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Bogota, Bogota, Colombia
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London Institute of Health Equity, London, England
| | - Paolo Vineis
- School of Public Health, Imperial College, St Mary's Campus, London, England
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
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Einiö E, Metsä-Simola N, Peltonen R, Martikainen P. Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke. Scand J Public Health 2023; 51:75-81. [PMID: 34609220 PMCID: PMC9900187 DOI: 10.1177/14034948211042501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse's death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse's death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse's death from stroke.
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Affiliation(s)
- Elina Einiö
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland,Elina Einiö, Population Research Unit,
Department of Social Research, Faculty of Social Sciences, University of
Helsinki, P.O. Box 18, 00014 Helsinki, Finland. E-mail:
| | - Niina Metsä-Simola
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland
| | - Riina Peltonen
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland,Laboratory of Population Health, Max
Planck Institute for Demographic Research, Germany,Department of Public Health Sciences,
Stockholm University, Sweden
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Einiö E, Metsä‐Simola N, Aaltonen M, Hiltunen E, Martikainen P. Partner violence surrounding divorce: A record-linkage study of wives and their husbands. J Marriage Fam 2023; 85:33-54. [PMID: 37063457 PMCID: PMC10087196 DOI: 10.1111/jomf.12881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study analyzes the victimization trajectories of partner violence against women surrounding divorce, depending on whether the couple has children together. BACKGROUND Prior studies have found that partner violence is associated with an increased risk of divorce. No study has assessed the victimization trajectories surrounding divorce for women with and without children, although women with children may remain at higher risk of violence following divorce. METHOD Using Finnish record-linkage data of 22,468 divorced and 333,542 continuously married women and their husbands, we used repeated-measures logistic regression analyses to assess changes in victimization for partner violence before and after divorce. The outcomes considered were police-reported crimes committed by husbands against their wives and hospital-treated assault injuries recorded for wives. RESULTS The risk of crime victimization for partner assault was already elevated from 2 to 3 years before divorce, peaked in the year prior to divorce, and then mainly leveled off 1-2 years after divorce. Hospital data show that the time of the greatest risk was from 6 to 12 months before divorce, when divorce is usually filed for. Women with younger children experienced elevated risks of physical violence shortly before divorce and remained at higher risk of menace than women without children for a year after divorce. CONCLUSION Divorcing women committed assaults against their husbands, but these were mostly accompanied by victimization, suggesting that resistant violence was common for women as perpetrators. Women with a history of victimization need support, especially at the starts of their divorce processes.
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Affiliation(s)
- Elina Einiö
- Population Research Unit, Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
| | - Niina Metsä‐Simola
- Population Research Unit, Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
| | - Mikko Aaltonen
- Law School, Faculty of Social Sciences and Business StudiesUniversity of Eastern FinlandJoensuuFinland
| | - Elina Hiltunen
- Population Research Unit, Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
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44
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Li P, Hu Y, Scelo G, Myrskylä M, Martikainen P. Pre-existing psychological disorders, diabetes, and pancreatic cancer: A population-based study of 38,952 Finns. Cancer Epidemiol 2023; 82:102307. [PMID: 36459909 DOI: 10.1016/j.canep.2022.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/30/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It remains unclear how pre-existing depression, anxiety, and diabetes of different durations are associated with the risk of pancreatic cancer, its clinical characteristics, treatment modalities, and subsequent survival. METHODS From a register-based random sample of Finns residing in Finland at the end of the period 1987-2007, 6492 patients diagnosed with primary pancreatic cancer in 2000-2014, and 32 460 controls matched for birth cohort and sex, were identified. Pre-existing depression, anxiety, and diabetes were ascertained from the records of prescribed medication purchases. Information on pancreatic cancer outcomes was obtained from the Finnish cancer register. Data were analyzed using logistic and Cox regressions. RESULTS The risk of developing pancreatic cancer was found to be associated with long-term anxiety (treatment started 36 + months before the cancer diagnosis) (odds ratio (OR): 1.13, 95% confidence interval (95%CI): 1.04-1.22) and long-term diabetes (OR 1.72, 95%CI 1.55-1.90), as well as with new-onset (treatment started 0-24 months before the cancer diagnosis) depression (OR 1.59, 95%CI 1.34-1.88), anxiety (OR 1.76, 95%CI 1.50-2.07), and diabetes (OR 3.92, 95%CI 3.44-4.48). However, the effects of these new-onset conditions were driven by cases that began treatment within 3 months before the cancer diagnosis (concomitant period). Patients with long-term depression, anxiety and diabetes and those with new-onset anxiety had a higher risk of not receiving standard treatments. Lower survival was found for pancreatic cancer patients with new-onset depression (hazards ratio (HR) 1.38, 95%CI 1.16-1.64). Survival was not associated with pre-existing anxiety or diabetes. CONCLUSIONS The associations between pancreatic cancer risk and pre-existing depression and anxiety were mostly driven by concomitant effects. Individuals with diabetes, regardless of duration, should be closely monitored for pancreatic cancer. Pancreatic cancer patients with new-onset depression should be targeted to improve their survival.
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Affiliation(s)
- Peng Li
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, China.
| | - Ghislaine Scelo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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45
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Hegvik TA, Klungsøyr K, Kuja-Halkola R, Remes H, Haavik J, D'Onofrio BM, Metsä-Simola N, Engeland A, Fazel S, Lichtenstein P, Martikainen P, Larsson H, Sariaslan A. Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings. Am J Obstet Gynecol 2023; 228:233.e1-233.e12. [PMID: 35973476 DOI: 10.1016/j.ajog.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder. Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect, and the causal nature of this association remains unknown. OBJECTIVE This study aimed to investigate the extent to which exposure to labor epidural analgesia is associated with offspring autism spectrum disorder and attention-deficit/hyperactivity disorder following adjustments for unmeasured familial confounding. STUDY DESIGN We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born from 1987-2005), Norway (1999-2015), and Sweden (1987-2011) linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6-16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (eg, at least 1 secondary care diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder or at least 1 dispensed prescription of medication used for the treatment of attention-deficit/hyperactivity disorder). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling comparisons. Pooled estimates across all the 3 countries were estimated using inverse variance weighted fixed-effects meta-analysis models. RESULTS A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with autism spectrum disorder and 4.0% with attention-deficit/hyperactivity disorder. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring autism spectrum disorder (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10-1.14, absolute risks, 1.20% vs 1.07%) and attention-deficit/hyperactivity disorder (adjusted hazard ratio, 1.20; 95% confidence interval, 1.19-1.21; absolute risks, 3.95% vs 3.32%). However, when comparing full siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions with narrow confidence intervals (adjusted hazard ratio [autism spectrum disorder], 0.98; 95% confidence interval, 0.93-1.03; adjusted hazard ratio attention-deficit/hyperactivity disorder, 0.99; 95% confidence interval, 0.96-1.02). CONCLUSION In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring autism spectrum disorder or attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jan Haavik
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IA
| | - Niina Metsä-Simola
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
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Tarkiainen L, Martikainen P. Long-term trends in urban-neighbourhood inequalities in cause-specific mortality and hospitalisation - multilevel analyses among individuals nested in Finnish post-code areas, 1991-2018. SSM Popul Health 2022; 21:101323. [PMID: 36589271 PMCID: PMC9798161 DOI: 10.1016/j.ssmph.2022.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background High-income countries yield mixed evidence concerning the long-term trends of neighbourhood inequalities in health outcomes. The reasons why these inequalities persist and the factors driving any changes over time remain unclear. We analysed trends in general neighbourhood differences in mortality and hospitalisation, compared specific area-level and individual-level income effects, and assessed whether area-level effects were attributable to the neighbourhood population composition. Methods This prospective cohort study used individual-level register-linked information on sociodemographic factors covering the total population of 20-64-year-olds living in Finnish cities at the beginning of seven four-year periods in 1991-2018 (N = 952,493-1,200,431). We used random-effects Poisson models to assess all-cause and external mortality and hospitalisations among individuals nested in postal-code areas. Results The general contextual effect of the neighbourhood on all-cause mortality and hospitalisation was stable across time, with a median incidence-rate ratio of around 1.20-1.30, and it was mainly attributable to the population's composition. The association between area-level income and both mortality and hospitalisation was also robust and increased slightly even after accounting for population composition. The lowest neighbourhood income quintile in 2015-2018 had 15% (95% CI:5-26%) and 30% (95% CI:15-47%) excess mortality among men and women, respectively. These differentials were particularly large for external causes, but all area-level income associations were much smaller than the corresponding individual-level associations. Conclusion The overall relevance of the neighbourhood context to mortality and hospitalisation was stable across time, and generally attributable to population composition. However, there were substantial relative area-level income disparities between neighbourhoods, which had grown over time.
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Affiliation(s)
- Lasse Tarkiainen
- University of Helsinki, Population Research Unit, URBARIA Helsinki Institute of Urban and Regional Studies, Unioninkatu 35, 00014, Helsingin Yliopisto, Finland,Corresponding author.
| | - Pekka Martikainen
- University of Helsinki, Population Research Unit, Helsinki, Finland,Max-Planck-Institute for Demographic Research, Rostock, Germany
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Hu Y, Korhonen K, Li P, Bobak M, Martikainen P, Bijlsma MJ. Association between alcohol use disorders and dementia in 262,703 dementia-free Finnish adults: Is cardiovascular disease a mediator? J Gerontol A Biol Sci Med Sci 2022:6917078. [DOI: 10.1093/gerona/glac252] [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] [Received: 05/18/2022] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
The possible mediating role of cardiovascular disease (CVD) in the relationship between alcohol use disorders (AUD) and the risk of early- (<age 65) and late-onset (≥age 65) dementia lacks formal investigation.
Methods
Using linked Finnish national register data, a population-based cohort study of 262,703 dementia-free Finnish men and women aged 40+ at baseline (December 31, 1999) was established. AUD and CVD in 1988-2014, and incident dementia in 2000-2014 were identified from Finnish Hospital Discharge Register and/or Drug Reimbursement Register. Causal association and mediation were assessed using mediational g-formula.
Results
AUD was associated with a substantial increase in the risk of early-onset dementia in both men (hazard ratio: 5.67, 95% confidence interval: 4.37-7.46) and women (6.13, 4.20-8.94) after adjustments for confounding; but the elevated risk for late-onset dementia was smaller (men: 2.01, 1.80-2.25; women: 2.03, 1.71-2.40). Mediational g-formula results showed that these associations were causal in men with no mediation by CVD as virtually identical total effect of AUD (early-onset: 5.26, 3.48-7.48; late-onset: 2.01, 1.41-2.87) and direct effect of AUD (early-onset: 5.24, 3.38-7.64; late-onset: 2.19, 1.61-2.96) were found with no indirect effect via CVD. In women, the results were similar for late-onset dementia (total effect: 2.80, 1.70-4.31; direct effect: 2.92, 1.86-4.62) but underpowered for early-onset dementia.
Conclusions
AUD increased dementia risk, particularly the risk of early-onset dementia. This elevated risk of dementia associated with AUD was not mediated by CVD. Clinicians should consider the increased risk of dementia in management of middle-aged and older adults with a history and/or current AUD.
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Affiliation(s)
- Yaoyue Hu
- School of Public Health, Chongqing Medical University , Chongqing, 400016 P.R. China
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , 00014 Helsinki, Finland
| | - Peng Li
- Laboratory of Population Health, Max Planck Institute for Demographic Research , 18057 Rostock, Germany
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London , London WC1E 6BT, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , 00014 Helsinki, Finland
- Laboratory of Population Health, Max Planck Institute for Demographic Research , 18057 Rostock, Germany
| | - Maarten J Bijlsma
- Laboratory of Population Health, Max Planck Institute for Demographic Research , 18057 Rostock, Germany
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48
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Remes H, Palma Carvajal M, Peltonen R, Martikainen P, Goisis A. The Well-Being of Adolescents Conceived Through Medically Assisted Reproduction: A Population-Level and Within-Family Analysis. Eur J Popul 2022; 38:915-949. [PMID: 36507233 PMCID: PMC9727010 DOI: 10.1007/s10680-022-09623-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Medically assisted reproduction (MAR) plays an increasingly important role in the realization of fertility intentions in advanced societies, yet the evidence regarding MAR-conceived children's longer-term well-being remains inconclusive. Using register data on all Finnish children born in 1995-2000, we compared a range of social and mental health outcomes among MAR- and naturally conceived adolescents in population-averaged estimates, and within families who have conceived both through MAR and naturally. In baseline models, MAR-conceived adolescents had better school performance and the likelihood of school dropout, not being in education or employment, and early home-leaving were lower than among naturally conceived adolescents. No major differences were found in mental health and high-risk health behaviours. Adjustment for family sociodemographic characteristics attenuated MAR adolescents' advantage in social outcomes, while increasing the risk of mental disorders. The higher probability of mental disorders persisted when comparing MAR adolescents to their naturally conceived siblings. On average, MAR adolescents had similar or better outcomes than naturally conceived adolescents, largely due to their more advantaged family backgrounds, which underscores the importance of integrating a sociodemographic perspective in studies of MAR and its consequences.
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Affiliation(s)
- Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
| | | | - Riina Peltonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Alice Goisis
- University College London, Social Research Institute, London, UK
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49
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Aradhya S, Tegunimataka A, Kravdal Ø, Martikainen P, Myrskylä M, Barclay K, Goisis A. Maternal age and the risk of low birthweight and pre-term delivery: a pan-Nordic comparison. Int J Epidemiol 2022; 52:156-164. [PMID: 36350574 PMCID: PMC9908063 DOI: 10.1093/ije/dyac211] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics. METHODS Using total population register data on all live singleton births during the period 1999-2012 in Denmark (N = 580 133; 90% population coverage), Norway (N = 540 890) and Sweden (N = 941 403) and from 2001-2014 in Finland (N = 568 026), we test whether advanced maternal age at birth independently increases the risk of low birthweight (LBW) (<2500 g) and pre-term birth (<37 weeks gestation). We estimated within-family models to reduce confounding by unobserved maternal characteristics shared by siblings using three model specifications: Model 0 examines the bivariate association; Model 1 adjusts for parity and sex; Model 2 for parity, sex and birth year. RESULTS The main results (Model 1) show an increased risk in LBW and pre-term delivery with increasing maternal ages. For example, compared with maternal ages of 26-27 years, maternal ages of 38-39 years display a 2.2, 0.9, 2.1 and 2.4 percentage point increase in the risk of LBW in Denmark, Finland, Norway and Sweden, respectively. The same patterns hold for pre-term delivery. CONCLUSIONS Advanced maternal age is independently associated with higher risk of poor perinatal health outcomes even after adjusting for all observed and unobserved factors shared between siblings.
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Affiliation(s)
- Siddartha Aradhya
- Demography Unit and Department of Sociology, Stockholm University, Stockholm, Sweden,Centre for Economic Demography, Lund University, Lund, Sweden
| | | | - Øystein Kravdal
- Department of Economics, University of Oslo, Oslo, Norway,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany,Population Research Unit and Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany,Population Research Unit and Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Kieron Barclay
- Corresponding author. Department of Sociology, Stockholm University, 106 91 Stockholm, Sweden. E-mail:
| | - Alice Goisis
- Social Research Institute, University College London, London, UK
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50
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Korhonen K, Leinonen T, Tarkiainen L, Einiö E, Martikainen P. Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators. Int J Epidemiol 2022; 52:523-535. [PMID: 36343014 PMCID: PMC10114069 DOI: 10.1093/ije/dyac205] [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] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health.
Methods
We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed.
Results
An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to <4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%).
Conclusions
The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Taina Leinonen
- Finnish Institute of Occupational Health , Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki , Helsinki, Finland
| | - Elina Einiö
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Max Planck Institute for Demographic Research , Rostock, Germany
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
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