How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.

Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity.

Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s.

The effects of marriage and separation on the psychotropic medication use of non-married cohabiters: a register-based longitudinal study among adult Finns.

Non-marital cohabitation has become increasingly common and is suggested to offer similar mental-health benefits as marriage does. We studied levels and changes in cohabiters' mental health five years before and five years after entering into marriage or separating, and compared long-term non-married and married cohabiters. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics, excluding medication for dementia) by proximity to non-marital transition and gender, using register data on 189,394 Finns aged 25 to 64.

Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s.

This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes.

Assessing the potential impact of increased participation in higher education on mortality: evidence from 21 European populations.

Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios.

Amenable mortality by household income and living arrangements: a linked register-based study of Finnish men and women in 2000-2007.

Background: Mortality amenable to healthcare interventions has increasingly been used as an indirect indicator of the effect of healthcare on health inequalities. Studies have consistently shown socioeconomic differences in amenable mortality, but evidence on the joint effects of multiple socioeconomic and demographic factors is limited. We examined whether income and living arrangements have an independent effect on amenable mortality taking into account other dimensions of social position.

The association between advanced maternal and paternal ages and increased adult mortality is explained by early parental loss.

The association between advanced maternal and paternal ages at birth and increased mortality among adult offspring is often attributed to parental reproductive aging, e.g., declining oocyte or sperm quality.

Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries.

Background: Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century.

Methods: We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia.

Effect of family background on the educational gradient in lifetime fertility of Finnish women born 1940-50.

An inverse association between education and fertility in women has been found in many societies but the causes of this association remain inadequately understood. We investigated whether observed and unobserved family-background characteristics explained educational differences in lifetime fertility among 35,212 Finnish women born in 1940-50. Poisson and logistic regression models, adjusted for measured socio-demographic family-background characteristics and for unobserved family characteristics shared by siblings, were used to analyse the relationship between education and the number of children, having any children, and fertility beyond the first child.

Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the "fundamental causes" theory of social inequalities in health.

Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities. We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century.

Non-employment histories of middle-aged men and women who died from alcohol-related causes: a longitudinal retrospective study.

Background: Long-term patterning of non-employment among problem drinkers is poorly understood. We determined the level and timing of non-employment, and the relative contribution of various types of non-employment among middle-aged persons who died of alcohol-related causes.

Methods: We conducted a longitudinal retrospective register-based study of Finnish men and women aged 45-64 years who died of alcohol-related causes (n = 15,552) or other causes (n = 39,166) in the period 2000-07, or who survived (n = 204,422) until the end of 2007.

The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking.

Introduction: This study assesses the effects of obesity, physical inactivity and smoking on life expectancy (LE) differences between educational groups in five European countries in the early 2000s.

Methods: We estimate the contribution of risk factors on LE differences between educational groups using the observed risk factor distributions and under a hypothetically more optimal risk factor distribution. Data on risk factor prevalence were obtained from the Survey of Health, Ageing and Retirement in Europe study, and data on mortality from census-linked data sets for the age between 50 and 79 according to sex and education.

Social differences in avoidable mortality between small areas of 15 European cities: an ecological study.

Background: Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.

Socioeconomic inequalities in mortality in 16 European cities.

Aims: To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators.

Methods: A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period.

Income differences in life expectancy: the changing contribution of harmful consumption of alcohol and smoking.

Background: Social differences in mortality have increased in high-income countries, but the causes of these changes remain unclear. We quantify the contribution of alcohol and smoking to trends in income differences in life expectancy from 1988 through 2007 in Finland.

Methods: An 11% sample from the population registration data of Finns 25 years and older was linked with an 80% oversample of death records.

Household income and health problems during a period of labour-market change and widening income inequalities - a study among the Finnish population between 1987 and 2007.

Income inequalities widened considerably from 1987 to 2007 in Finland. We compared the association between household income and health problems across three periods and in several different ways of modelling the dependence. Our aim was to find out whether the change in the distribution of income might have led to wider income-related inequalities in health problems.

Life expectancy in long-term institutional care by marital status: multistate life table estimates for older Finnish men and women.

Objectives: We estimate (a) probabilities of moving to and from long-term institutional care and probabilities of death and (b) life expectancy in the community and in care by gender and marital status.

Method: A 40% random sample of Finns aged 65+ at the end of 1997 (n = 301,263) drawn from the population register was linked with register-based information on sociodemographic characteristics, entry and exit dates for long-term institutional care, and dates of death in 1998-2003. Probabilities and life expectancies were estimated using multistate life tables.

Socioeconomic status across the life course and all-cause and cause-specific mortality in Finland.

We used high quality register based data to study the relationship between childhood and adult socio-demographic characteristics and all-cause and cause-specific mortality at ages 35-72 in Finland among cohorts born in 1936-1950. The analyses were based on a 10% sample of households drawn from the 1950 Finnish Census of Population with the follow-up of household members in subsequent censuses and death records beginning from the end of 1970 through the end of 2007. The strengths of these data come from the fact that neither childhood nor adult characteristics are self reported and thus are not subject to recall bias, misreporting and no loss to follow-up after age 35.

The contribution of major diagnostic causes to socioeconomic differences in disability retirement.

Objectives: The aim of this study was twofold: to investigate socioeconomic differences in disability retirement (DR) due to major diseases and find out which diseases contribute most to the overall socioeconomic differences in DR.

Methods: The data were longitudinal register-based (10% sample of Finns) from Statistics Finland. These data included 258 428 participants aged 35-64 years during the follow-up.

Lifespan variation by occupational class: compression or stagnation over time?

Cross-sectional analyses of adult lifespan variation have found an inverse association between socioeconomic position and lifespan variation, but the trends by social class are unknown. We investigated trends in lifespan variation over four decades (1971-2010) by occupational social class (manual, lower nonmanual, upper nonmanual, other) using Finnish register data. We performed age and cause-of-death decompositions of lifespan variation for each sex (a) by occupational class over time and (b) between occupational classes at a shared level of life expectancy.

Smoking and the potential for reduction of inequalities in mortality in Europe.

Socioeconomic inequalities in health and mortality remain a widely recognized problem. Countries with smaller inequalities in smoking have smaller inequalities in mortality, and smoking plays an important part in the explanation of inequalities in some countries. We identify the potential for reducing inequalities in all-cause and smoking-related mortality in 19 European populations, by applying different scenarios of smoking exposure.

Educational inequalities in three smoking-related causes of death in 18 European populations.

Introduction: Smoking is an important determinant of socioeconomic inequalities in mortality in many countries. As the smoking epidemic progresses, updates on the development of mortality inequalities attributable to smoking are needed. We provide estimates of relative and absolute educational inequalities in mortality from lung cancer, aerodigestive cancers, and chronic obstructive pulmonary disease (COPD)/asthma in Europe and assess the contribution of these smoking-related diseases to inequalities in all-cause mortality.

Occupational class differences in body mass index and weight gain in Japan and Finland.

Background: Occupational class differences in body mass index (BMI) have been systematically reported in developed countries, but the studies have mainly focused on white populations consuming a Westernized diet. We compared occupational class differences in BMI and BMI change in Japan and Finland.

Methods: The baseline surveys were conducted during 1998-1999 among Japanese (n = 4080) and during 2000-2002 among Finnish (n = 8685) public-sector employees.

Socioeconomic inequalities in injury mortality in small areas of 15 European cities.

This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century. A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model.

The contribution of health policy and care to income differences in life expectancy--a register based cohort study.

Background: Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods.