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  • 1. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Latvala, Antti
    Associations Between Cohabitation, Marriage, and Suspected Crime: a Longitudinal Within-Individual Study2023In: Journal of developmental and life course criminology, ISSN 2199-4641, Vol. 9, no 1, p. 54-70Article in journal (Refereed)
    Abstract [en]

    The effects of marriage on criminal behavior have been studied extensively. As marriages today are typically preceded by cohabiting relationships, there is a growing need to clarify how different relationship types are associated with criminality, and how these effects may be modified by relationship duration, partner's criminality, and crime type. We used Finnish longitudinal register data and between- and within-individual analyses to examine how cohabitation and marriage were associated with suspected crime. The data included 638,118 residents of Finland aged 0-14 in 2000 and followed for 17 years for a suspected crime: having been suspected of violent, drug, or any crime. Between-individual analyses suggested that those who were cohabiting or married had a 40-65% lower risk of being suspected of a crime compared to those who were single, depending on the type of crime. The within-individual analysis showed a 25-50% lower risk for suspected crime when people were cohabiting or married compared to time periods when they were single. Those in a relationship with a criminal partner had 11 times higher risk for suspected crime than those in a relationship with a non-criminal partner. Forming a cohabiting relationship with a non-criminal partner was associated with reduced criminality. The risk reduction was not fully explained by selection effects due to between-individual differences. Marriage did not introduce further reduction to criminality. Our findings demonstrate that selection effects partly explain the association between relationship status and criminality but are also compatible with a causal effect of cohabitation on reduced risk of being suspected of a crime.

  • 2. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max-Planck-Institute for Demographic Research, Germany.
    Latvala, Antti
    Associations of neighborhood disadvantage and offender concentration with criminal behavior: Between-within analysis in Finnish registry data2021In: Journal of criminal justice, ISSN 0047-2352, E-ISSN 1873-6203, Vol. 74, article id 101813Article in journal (Refereed)
    Abstract [en]

    The association between neighborhood disadvantage and crime has been extensively studied, but most studies have relied on cross-sectional data and have been unable to separate potential effects of the neighborhood from selection effects. We examined how neighborhood disadvantage and offender concentration are associated with criminal behavior while accounting for selection effects due to unobserved time-invariant characteristics of the individuals. We used a registry-based longitudinal dataset that included all children aged 0-14 living in Finland at the end of year 2000 with follow-up until the end of 2017 for criminal offences committed at ages 18-31 years (n = 510,189). Using multilevel logistic regression with a between-within approach we examined whether neighborhoods differed in criminal behavior and whether within-individual changes in neighborhood disadvantage and offender concentration were associated with within-individual changes in criminal behavior. Our results indicated strong associations of most measures of neighborhood disadvantage and offender concentration with criminal behavior between individuals. The within-individual estimates accounting for selection related to unobserved individual characteristics were mostly non-significant with the exception of higher neighborhood disadvantage being associated with increased risk for violent crimes. Our findings suggest that criminal behavior is better explained by individual characteristics than by causal effects of neighborhoods.

  • 3. Avendano, Mauricio
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 1, p. 77-85Article in journal (Refereed)
    Abstract [en]

    This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989-1996) and recovery (1997-2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989-1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997-2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.

  • 4. Barbuscia, Anna
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Myrskylä, Mikko
    Remess, Hanna
    Somigliana, Edgardo
    Klemetti, Reija
    Goisis, Alice
    Maternal age and risk of low birth weight and premature birth in children conceived through medically assisted reproduction. Evidence from Finnish population registers2020In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 35, no 1, p. 212-220Article in journal (Refereed)
    Abstract [en]

    STUDY QUESTION: Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)?

    SUMMARY ANSWER: Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+).

    WHAT IS KNOWN ALREADY: The use of MAR treatments has been increasing over the last few decades and is especially diffused among women who conceive at older ages. Although advanced maternal age is a well-known risk factor for adverse birth outcomes in natural pregnancies, only a few studies have directly analysed the maternal age gradient in birth outcomes for MAR mothers.

    STUDY DESIGN, SIZE, DURATION: The base dataset was a 20% random sample of households with at least one child aged 0-14 at the end of 2000, drawn from the Finnish population register and other administrative registers. This study included children who were born in 1995-2000, because the information on whether a child was conceived through MAR or naturally was available only from 1995 onwards.

    PARTICIPANTS/MATERIALS, SETTING, METHODS: The outcome measures were whether the child had low birth weight (LBW, <2500 g at birth) and whether the child was delivered preterm (<37 weeks of gestation). Conceptions through MAR were identified by examining data on purchases of prescription medication from the National Prescription Register. Linear probability models were used to analyse and compare the maternal age gradients in birth outcomes of mothers who conceived through MAR or naturally before and after adjustment for maternal characteristics (i.e. whether the mother suffered from acute/chronic conditions before the pregnancy, household income and whether the mother smoked during pregnancy).

    MAIN RESULTS AND THE ROLE OF CHANCE: A total of 56026 children, 2624 of whom were conceived through MAR treatments, were included in the study. Among the mothers who used MAR to conceive, maternal age was not associated with an increased risk of LBW (the overall prevalence was 12.6%) at ages 25-39. For example, compared to the risk of LBW at ages 30-34, the risk was 0.22 percentage points lower (95% CI: -3.2, 2.8) at ages 25-29 and was 1.34 percentage points lower (95% CI: -4.5, 1.0) at ages 35-39. The risk of LBW was increased only at maternal ages >= 40 (six percentage points, 95% CI: 0.2, 12). Adjustment for maternal characteristics only marginally attenuated these associations. In contrast, among the mothers who conceived naturally, the results showed a clear age gradient. For example, compared to the risk of LBW (the overall prevalence was 3.3%) at maternal ages 30-34, the risk was 1.1 percentage points higher (95% CI: 0.6, 1.6) at ages 35-39 and was 1.5 percentage points higher (95% CI: 0.5, 2.6) at ages >= 40. The results were similar for preterm births.

    LIMITATIONS, REASON FOR CAUTION: A limited number of confounders were included in the study because of the administrative nature of the data used. Our ability to reliably distinguish mothers based on MAR treatment type was also limited. WIDER

    IMPLICATIONS OF THE FINDINGS: This is the first study to analyse the maternal age gradient in the risk of adverse birth outcomes among children conceived through MAR using data from a nationally representative sample and controlling for important maternal health and socio-economic characteristics. This topic is of considerable importance in light of the widespread and increasing use of MAR treatments.

  • 5. Bijlsma, Maarten J.
    et al.
    Tarkiainen, Lasse
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany: University of Helsinki,, Finland.
    Unemployment and subsequent depression: A mediation analysis using the parametric G-formula2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 194, p. 142-150Article in journal (Refereed)
    Abstract [en]

    The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.

  • 6. Bijlsma, Maarten J.
    et al.
    Wilson, Ben
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, United Kingdom.
    Tarkiainen, Lasse
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    The Impact of Unemployment on Antidepressant Purchasing: Adjusting for Unobserved Time-constant Confounding in the g-Formula2019In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 30, no 3, p. 388-395Article in journal (Refereed)
    Abstract [en]

    Background: The estimated effect of unemployment on depression may be biased by time-varying, intermediate, and time-constant confounding. One of the few methods that can account for these sources of bias is the parametric g-formula, but until now this method has required that all relevant confounders be measured.

    Methods: We combine the g-formula with methods to adjust for unmeasured time-constant confounding. We use this method to estimate how antidepressant purchasing is affected by a hypothetical intervention that provides employment to the unemployed. The analyses are based on an 11% random sample of the Finnish population who were 30–35 years of age in 1995 (n = 49,753) and followed until 2012. We compare estimates that adjust for measured baseline confounders and time-varying socioeconomic covariates (confounders and mediators) with estimates that also include individual-level fixed-effect intercepts.

    Results: In the empirical data, around 10% of person-years are unemployed. Setting these person-years to employed, the g-formula without individual intercepts found a 5% (95% confidence interval [CI] = 2.5%, 7.4%) reduction in antidepressant purchasing at the population level. However, when also adjusting for individual intercepts, we find no association (−0.1%; 95% CI = −1.8%, 1.5%).

    Conclusions: The results indicate that the relationship between unemployment and antidepressants is confounded by residual time-constant confounding (selection). However, restrictions on the effective sample when using individual intercepts can compromise the validity of the results. Overall our approach highlights the potential importance of adjusting for unobserved time-constant confounding in epidemiologic studies and demonstrates one way that this can be done.

  • 7. Diaconu, Viorela
    et al.
    van Raalte, Alyson
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Why we should monitor disparities in old-age mortality with the modal age at death2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263626Article in journal (Refereed)
    Abstract [en]

    Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly. 

  • 8. Einio, Elina
    et al.
    Hiltunen, Elina
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland.
    Korhonen, Kaarina
    Men's age at first birth and alcohol-related morbidity and mortality among siblings2020In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 209, article id 107942Article in journal (Refereed)
    Abstract [en]

    Background: Men's age at first birth may negatively or positively affect alcohol-related morbidity and mortality, although little evidence is available. Methods: We used register data of over 22,000 brothers to analyze the associations between age at first birth and alcohol-related morbidity and mortality from the age of 35 until the age of 60 or 72. We employed conventional Cox models and inter-sibling models, which allowed adjustment for unobserved social and genetic characteristics shared by brothers. Results: The findings show that men's age at first birth was inversely associated with alcohol-related morbidity and mortality, independent of unobserved characteristics shared by brothers and of observed demographic confounders. Men who had their first child late at 35-45 years experienced lower alcohol-related morbidity and mortality (hazard ratio (HR) = 0.57, 95 % confidence interval (CI) = 0.43, 0.75) than men who had their first child at 25-29. Men who had their first child before age 20 had the highest morbidity and mortality among all fathers (HR = 1.36, 95 % CI = 1.09, 1.69), followed by men who had their child at 20-24 (HR = 1.12, 95 % CI = 1.00, 1.25). Conclusions: The results imply that the inverse association between men's age at first birth and alcohol-related morbidity and mortality is not driven by familial characteristics.

  • 9. Einiö, Elina
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996-2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.

  • 10. Einiö, Elina
    et al.
    Metsä-Simola, Niina
    Saarioja, Saska
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Korhonen, Kaarina
    Is impending or actual death of a spouse with dementia bad for mental health? Antidepressant use surrounding widowhood2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no 5, p. 953-957Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown that the risk of death is elevated after the death of a spouse. Limited evidence is available on changes in mental health before and after bereavement among individuals whose spouse dies of dementia. Methods: We analyzed changes in the 3-month prevalence of antidepressant use for 5 years before and 3 years after widowhood for individuals whose spouses died of either dementia or other causes. The study used data of 41 855 widowed individuals and repeated-measures logistic regression analyses. Antidepressant use was based on the prescription register of Finland in 1995-2007. Results: Five years before widowhood, the 3-month prevalence for antidepressant use was 4% among widowing men and 6-7% among widowing women, regardless of whether the spouse died of dementia or other causes. Further changes in antidepressant use depended on a spouse's cause of death. Women whose spouses died of dementia experienced large increase in antidepressant use starting from 3 to 4 years prior to widowhood, whereas other widows did not experience large increase until after widowhood. The trajectories for men were similar. Antidepressant use following the death of a spouse with dementia stayed at a new heightened level after widowhood. Conclusions: The trajectories of antidepressant use indicate that the process of losing a spouse to dementia is bad for mental health, already a few years prior to widowhood. There are no clear improvements in mental health after the death of a spouse with dementia. Support services for individuals whose spouses' dementia progresses are needed.

  • 11. Einiö, Elina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Leinonen, Taina
    Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 599-605Article in journal (Refereed)
    Abstract [en]

    Background The death of a spouse has been shown to increase mortality from various causes, including ischaemic heart disease. It is unclear, however, whether cardiac problems are already on the rise before widowhood.

    Methods Using longitudinal register data of Finnish widows-to-be aged 65 and over at baseline (N=19 185), we assessed the risk of hospitalisation for ischaemic heart disease 18 months before and after widowhood. Hospital admissions were derived from national hospital discharge registers between 1996 and 2002. Analyses used population-averaged and fixed-effects logistic models, the latter of which controlled for unobserved time-invariant characteristics, such as genetic susceptibility, personality and behavioural and medical history.

    Results For men, fixed-effects model revealed that hospitalisation for ischaemic heart disease increased twofold already 0–3 months prior to the death of a spouse (OR=2.09, 95% CI 1.22 to 3.60), relative to the period of 15–18 months before widowhood. It stayed at a heightened level up to 6 months following bereavement (OR=2.15, 95% CI 1.07 to 4.30). Among women, the fixed-effects analysis detected no statistically significant increase in hospitalisation for ischaemic heart disease before or after widowhood.

    Conclusions These findings indicate that men are already vulnerable to cardiac problems before the death of a wife. Medical interventions and health counselling could be targeted to the husbands of terminally ill patients, in order to improve their cardiovascular health over the transition to widowhood.

  • 12. Einiö, Elina
    et al.
    Nisén, Jessica
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Number of children and later-life mortality among Finns born 1938-502016In: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 70, no 2, p. 217-238Article in journal (Refereed)
    Abstract [en]

    We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938–50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50–72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.

  • 13. Elo, Irma T.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Aaltonen, Mikko
    Children's educational attainment, occupation, and income and their parents' mortality2018In: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 72, no 1, p. 53-73Article in journal (Refereed)
    Abstract [en]

    Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970-2007. Higher levels of children's education are associated with 30-36 per cent lower parental mortality at ages 50-75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11-16 per cent lower all-cause mortality at ages 50-75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39-46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.

  • 14. Elstad, Jon Ivar
    et al.
    Hermansen, Åsmund
    Brønnum-Hansen, Henrik
    Martikainen, Pekka
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Tarkiainen, Lasse
    Income security in Nordic welfare states for men and women who died when aged 55–69 years old2019In: Journal of International and Comparative Social Policy, ISSN 2169-9763, E-ISSN 2169-978X, Vol. 35, no 2, p. 157-176Article in journal (Refereed)
    Abstract [en]

    Income security when health impairment or other social risks occur is a major objective of welfare states. This comparative study uses register data from four Nordic welfare states for examining equivalized disposable income during the last 12 years alive among men and women who died when aged 55–69 years old. The analysed outcome indicates the aggregate result of a varied set of income maintenance mechanisms. Median income increased in the Finnish, Norwegian and Swedish samples, but decreased somewhat in Denmark, probably due to relatively frequent transitions to retirement and larger income drops after retirement than in the other Nordic countries. Analyses of comparison samples weighted by propensity scores indicated a better income development among those who lived beyond the observation period than among those who died. The higher educated had a more favourable income development during the years prior to death than those with low education.

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  • 15. Goisis, Alice
    et al.
    Remes, Hanna
    Barclay, Kieron
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, United Kingdom; Max Planck Institute for Demographic Research, Germany.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Myrskylä, Mikko
    Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 186, no 11, p. 1219-1226Article in journal (Refereed)
    Abstract [en]

    Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (< 2,500 g) and preterm birth (< 37 weeks' gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987-2000. When compared with maternal ages 25-29 years in between-family models, maternal ages of 35-39 years and a parts per thousand<yen>40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births.

  • 16. Goisis, Alice
    et al.
    Remes, Hanna
    Barclay, Kieron
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Myrskylä, Mikko
    Paternal age and the risk of low birth weight and preterm delivery: a Finnish register-based study2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 12, p. 1104-1109Article in journal (Refereed)
    Abstract [en]

    Background Based on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes. Methods We used Finnish population registers on 106652 children born 1987-2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500g) and preterm birth (<37 weeks' gestation). Second, we investigate whether the unadjusted association is attenuated on adjustment for child's, maternal and parental socioeconomic characteristics. Third, by adopting a within-family design which involves comparing children born to the same father at different ages, we additionally adjust for unobserved parental characteristics shared between siblings. Results The unadjusted results show that being born to a father aged 40+, as opposed to a father aged 30-34, is associated with an increased risk of LBW of 0.96% (95%CI 0.5% to 1.3%) and to a younger father (<25) with a 1% (95%CI 0.6% to 1.3%) increased risk. The increased risk at younger paternal ages is halved on adjustment for the child's characteristics and fully attenuated on adjustment for child/parental characteristics. The increased risk at paternal ages 40+ ispartially attenuated on adjustment for maternal characteristics (=0.62%; 95%CI 0.13% to 1.1%). Adjustment for unobserved parental characteristics shared by siblings further attenuates the 40+ coefficient (=0.4%; 95%CI -0.5% to -1.2%). Results for preterm delivery are similar. Conclusions The results underscore the importance of considering paternal age as a potential risk factor for adverse birth outcomes and of expanding research on its role and the mechanisms linking it to birth outcomes.

  • 17. Goisis, Alice
    et al.
    Remes, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Klemetti, Reija
    Myrskylä, Mikko
    Medically assisted reproduction and birth outcomes: a within-family analysis using Finnish population registers2019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10177, p. 1225-1232Article in journal (Refereed)
    Abstract [en]

    Background Children born after medically assisted reproduction are at higher risk of adverse birth outcomes than are children conceived naturally. We aimed to establish the extent to which this excess risk should be attributed to harmful effects of treatment or to pre-existing parental characteristics that confound the association. Methods We used data from Finnish administrative registers covering a 20% random sample of households with at least one child aged 0-14 years at the end of 2000 (n=65 723). We analysed birthweight, gestational age, risk of low birthweight, and risk of preterm birth among children conceived both by medically assisted reproduction and naturally. First, we estimated differences in birth outcomes by mode of conception in the general population, using standard multivariate methods that controlled for observed factors (eg, multiple birth, birth order, and parental sociodemographic characteristics). Second, we used a sibling-comparison approach that has not been used before in medically assisted reproduction research. We compared children conceived by medically assisted reproduction with siblings conceived naturally and, thus, controlled for all observed and unobserved factors shared by siblings. Findings Between 1995 and 2000, 2776 (4%) children in our sample were conceived by medically assisted reproduction; 1245 children were included in the sibling comparison. Children conceived by medically assisted reproduction had worse outcomes than did those conceived naturally, for all outcomes, even after adjustments for observed child and parental characteristics-eg, difference in birthweight of -60 g (95% CI -86 to -34) and 2.15 percentage point (95% CI 1.07 to 3.24) increased risk of preterm delivery. In the sibling comparison, the gap in birth outcomes was attenuated, such that the relation between medically assisted reproduction and adverse birth outcomes was statistically and substantively weak for all outcomes-eg, difference in birthweight of -31 g (95% CI -85 to 22) and 1.56 percentage point (95% CI -1.26 to 4.38) increased risk of preterm delivery. Interpretation Children conceived by medically assisted reproduction face an elevated risk of adverse birth outcomes. However, our results indicate that this increased risk is largely attributable to factors other than the medically assisted reproduction treatment itself.

  • 18.
    Gurzo, Klara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Max Planck Institute for Demographic Research, Germany.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Pathways from Childhood Economic Conditions to Adult Mortality in a 1953 Stockholm Cohort: The Intermediate Role of Personal Attributes and Socioeconomic Career2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 12, article id 7279Article in journal (Refereed)
    Abstract [en]

    Although both childhood and adult economic conditions have been found to be associated with mortality, independently or in combination with each other, less is known about the role of intermediate factors between these two life stages. This study explores the pathways between childhood economic conditions and adult mortality by taking personal attributes as well as adult socioeconomic career into consideration. Further, we investigate the role of intergenerational income mobility for adult mortality. We used data from a prospective cohort study of individuals that were born in 1953 and residing in Stockholm, Sweden, in 1963 who were followed for mortality between 2002 and 2021 (n = 11,325). We fit Cox proportional hazards models to assess the association of parental income, cognitive ability, social skills, educational attainment, occupational status, and adult income with mortality. The income mobility is operationalized as the interaction between parental and adult income. Our results show that the association between parental income and adult mortality is modest and largely operates through cognitive ability and adult educational attainment. However, our results do not provide support for there being an effect of intergenerational income mobility on adult mortality. In a Swedish cohort who grew up in a comparatively egalitarian society during the 1950s and 1960s, childhood economic conditions were found to play a distinct but relatively small role for later mortality.

  • 19.
    Gurzo, Klara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    The Impact of Privileged Classroom Friends on Adult Income and Income Mobility: A Study of a Swedish Cohort Born in 1953 2023In: Social Forces, ISSN 0037-7732, E-ISSN 1534-7605, Vol. 102, no 3, p. 1068-1088Article in journal (Refereed)
    Abstract [en]

    Social relationships across and within generations are associated with intergenerational income mobility. Parents affect their children’s future opportunities through socialization and by conveying various resources to the child during upbringing. However, self-acquired social contacts of children, such as friendships in school, might also affect long-term outcomes. Children from less privileged homes may gain access to additional resources through contact with privileged friends and their parents. This study examines whether having a classroom friend with high parental income (privileged friend) is associated with upward income mobility. Furthermore, it explores where in the parental income distribution a privileged friend matters most. We use data from the Stockholm Birth Cohort Multigenerational Study (n = 10,641), which is a prospective study of individuals born in 1953 who lived in the greater Stockholm area in 1963. We fit classroom fixed-effects models to estimate the association between having a privileged childhood friend and adult income as well as parental income and adult income along with the interaction of privileged friend and parental income. Results show that cohort members who had a privileged classroom friend had higher adult income, and that this income gain was greater among those whose parents belonged to the lowest income quartile, compared with those whose parents had higher incomes. These results are robust to adjustments for childhood socioeconomic background, personal attributes, and adult educational attainment. Our findings indicate that having an economically privileged friend in the school class bolsters adult income and upward income mobility of children from families with low income.

  • 20. Haukka, Jari
    et al.
    Suvisaari, Jaana
    Sarvimaki, Matti
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    The Impact of Forced Migration on Mortality A Cohort Study of 242,075 Finns from 1939-20102017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 587-593Article in journal (Refereed)
    Abstract [en]

    Background: The stresses and life changes associated with migration may have harmful long-term health effects, especially for mental health. These effects are exceedingly difficult to establish, because migrants are typically a highly selected group.

    Methods: We examined the impact of migration on health using naturally occurring historical events. In this article, we use the forced migration of 11% of the Finnish population after WWII as such a natural experiment. We observed the date and cause of death starting from 1 January 1971 and ending in 31 December 2010 for the cohort of 242,075 people. Data were obtained by linking individual-level data from the 1950 and 1970 population censuses and the register of death certificates from 1971 to 2010 (10% random sample). All-cause and cause-specific mortalities were modeled using Poisson regression.

    Results: Models with full adjustment for background variables showed that both all-cause mortality (RR 1.03, 95% CI 1.01, 1.05), and ischemic heart disease mortality (RR 1.11, 95% CI 1.08, 1.15) were higher in the displaced population than in the nondisplaced population. Suicide mortality was lower (RR 0.77, 95% CI 0.64, 0.92) in displaced than in the general population.

    Conclusions: In our long-term follow-up study, forced migration was associated with increased risk of death due to ischemic heart diseases. In contrast, lower suicide mortality was observed in association with forced migration 25 years or more.

  • 21. Hegvik, Tor-Arne
    et al.
    Klungsøyr, Kari
    Kuja-Halkola, Ralf
    Remes, Hanna
    Haavik, Jan
    D'Onofrio, Brian M.
    Metsä-Simola, Niina
    Engeland, Anders
    Fazel, Seena
    Lichtenstein, Paul
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Germany.
    Larsson, Henrik
    Sariaslan, Amir
    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 siblings2023In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 228, no 2, p. 233.e1-233.e12Article in journal (Refereed)
    Abstract [en]

    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.

  • 22. Hendi, Arun S.
    et al.
    Elo, Irma T.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    The implications of changing education distributions for life expectancy gradients2021In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 272, article id 113712Article in journal (Refereed)
    Abstract [en]

    Recent research has proposed that shifting education distributions across cohorts are influencing estimates of educational gradients in mortality. We use data from the United States and Finland covering four decades to explore this assertion. We base our analysis around our new finding: a negative logarithmic relationship between relative education and relative mortality. This relationship holds across multiple age groups, both sexes, two very different countries, and time periods spanning four decades. The inequality parameters from this model indicate increasing relative mortality differentials over time. We use these findings to develop a method that allows us to compute life expectancy for any given segment of the education distribution (e.g., education quintiles). We apply this method to Finnish and American data to compute life expectancy gradients that are adjusted for changes in the education distribution. In Finland, these distribution-adjusted education differentials in life expectancy between the top and bottom education quintiles have increased by two years for men, and remained stable for women between 1971 and 2010. Similar distribution-adjusted estimates for the U.S. suggest that educational disparities in life expectancy increased by 3.3 years for non-Hispanic white men and 3.0 years for non-Hispanic white women between the 1980s and 2000s. For men and women, respectively, these differentials between the top and bottom education quintiles are smaller than the differentials between the top and bottom education categories by 18% and 39% in the U.S. and by 39% and 100% in Finland. Had the relative inequality parameters of mortality governing the Finnish and U.S. populations remained constant at their earliest period values, the difference in life expectancy between the top and bottom education quintiles would – because of overall mortality reductions – have declined moderately. The findings suggest that educational expansion may bias estimates of trends in educational differences in life expectancy upwards.

  • 23. Herttua, Kimmo
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Batty, G. David
    Kivimäki, Mika
    Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke2016In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 67, no 13, p. 1507-1515Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Poor adherence to medication regimens is common, potentially contributing to the occurrence of related disease. OBJECTIVES The authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/ or antihypertensive therapy. METHODS We conducted a population-based study using electronic medical and prescription records from Finnish national registers in 1995 to 2007. Of the 58,266 hypercholesterolemia patients age 30+ years without pre-existing stroke or cardiovascular disease, 532 patients died of stroke (cases), and 57,734 remained free of incident stroke (controls) during the mean follow-up of 5.5 years. We captured year-by-year adherence to statin and antihypertensive therapy in both study groups and estimated the excess risk of stroke death associated with nonadherence. RESULTS In all hypercholesterolemia patients, the adjusted odds ratio for stroke death for nonadherent compared with adherent statin users was 1.35 (95% confidence interval [CI] 1.04 to 1.74) 4 years before and 2.04 (95% CI: 1.72 to 2.43) at the year of stroke death or the end of the follow-up. In hypercholesterolemia patients with hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 (95% CI: 5.22 to 10.59) for those nonadherent both to statin and antihypertensive therapy, 1.82 (95% CI: 1.43 to 2.33) for those non-adherent to statin but adherent to antihypertensive therapy, and 1.30 (95% CI: 0.53 to 3.20) for those adherent to statin, but nonadherent to antihypertensive, therapy. CONCLUSIONS Individuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies.

  • 24. Herttua, Kimmo
    et al.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 12, p. 1168-1176Article in journal (Refereed)
    Abstract [en]

    Background: Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden.

    Methods: Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988–2007 and in Sweden in 1991–2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol.

    Results: Among Finnish men with secondary education,an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women.

    Conclusions: Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.

  • 25. Howe, Laurence J.
    et al.
    Nivard, Michel G.
    Morris, Tim T.
    Hansen, Ailin F.
    Rasheed, Humaira
    Cho, Yoonsu
    Chittoor, Geetha
    Ahlskog, Rafael
    Lind, Penelope A.
    Palviainen, Teemu
    van der Zee, Matthijs D.
    Cheesman, Rosa
    Mangino, Massimo
    Wang, Yunzhang
    Li, Shuai
    Klaric, Lucija
    Ratliff, Scott M.
    Bielak, Lawrence F.
    Nygaard, Marianne
    Giannelis, Alexandros
    Willoughby, Emily A.
    Reynolds, Chandra A.
    Balbona, Jared
    Andreassen, Ole A.
    Ask, Helga
    Baras, Aris
    Bauer, Christopher R.
    Boomsma, Dorret
    Campbell, Archie
    Campbell, Harry
    Chen, Zhengming
    Christofidou, Paraskevi
    Corfield, Elizabeth
    Dahm, Christina C.
    Dokuru, Deepika R.
    Evans, Luke M.
    de Geus, Eco J. C.
    Giddaluru, Sudheer
    Gordon, Scott D.
    Harden, K. Paige
    Hill, W. David
    Hughes, Amanda
    Kerr, Shona M.
    Kim, Yongkang
    Kweon, Hyeokmoon
    Latvala, Antti
    Lawlor, Deborah A.
    Li, Liming
    Lin, Kuang
    Magnus, Per
    Magnusson, Patrik K. E.
    Mallard, Travis T.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Mills, Melinda C.
    Njolstad, Pal Rasmus
    Overton, John D.
    Pedersen, Nancy L.
    Porteous, David J.
    Reid, Jeffrey
    Silventoinen, Karri
    Southey, Melissa C.
    Stoltenberg, Camilla
    Tucker-Drob, Elliot M.
    Wright, Margaret J.
    Hewitt, John K.
    Keller, Matthew C.
    Stallings, Michael C.
    Lee, James J.
    Christensen, Kaare
    Kardia, Sharon L. R.
    Peyser, Patricia A.
    Smith, Jennifer A.
    Wilson, James F.
    Hopper, John L.
    Hagg, Sara
    Spector, Tim D.
    Pingault, Jean-Baptiste
    Plomin, Robert
    Havdahl, Alexandra
    Bartels, Meike
    Martin, Nicholas G.
    Oskarsson, Sven
    Justice, Anne E.
    Millwood, Iona Y.
    Hveem, Kristian
    Naess, Oyvind
    Willer, Cristen J.
    Asvold, Bjorn Olav
    Koellinger, Philipp D.
    Kaprio, Jaakko
    Medland, Sarah E.
    Walters, Robin G.
    Benjamin, Daniel J.
    Turley, Patrick
    Evans, David M.
    Smith, George Davey
    Hayward, Caroline
    Brumpton, Ben
    Hemani, Gibran
    Davies, Neil M.
    Within-sibship genome-wide association analyses decrease bias in estimates of direct genetic effects2022In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 54, no 5, p. 581-592Article in journal (Refereed)
    Abstract [en]

    Estimates from genome-wide association studies (GWAS) of unrelated individuals capture effects of inherited variation (direct effects), demography (population stratification, assortative mating) and relatives (indirect genetic effects). Family-based GWAS designs can control for demographic and indirect genetic effects, but large-scale family datasets have been lacking. We combined data from 178,086 siblings from 19 cohorts to generate population (between-family) and within-sibship (within-family) GWAS estimates for 25 phenotypes. Within-sibship GWAS estimates were smaller than population estimates for height, educational attainment, age at first birth, number of children, cognitive ability, depressive symptoms and smoking. Some differences were observed in downstream SNP heritability, genetic correlations and Mendelian randomization analyses. For example, the within-sibship genetic correlation between educational attainment and body mass index attenuated towards zero. In contrast, analyses of most molecular phenotypes (for example, low-density lipoprotein-cholesterol) were generally consistent. We also found within-sibship evidence of polygenic adaptation on taller height. Here, we illustrate the importance of family-based GWAS data for phenotypes influenced by demographic and indirect genetic effects. Within-sibship genome-wide association analyses using data from 178,076 siblings illustrate differences between population-based and within-sibship GWAS estimates for phenotypes influenced by demographic and indirect genetic effects.

  • 26. Hu, Yaoyue
    et al.
    Leinonen, Taina
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Changes in Socioeconomic Differences in Hospital Days With Age: Cumulative Disadvantage, Age-as-Leveler, or Both?2020In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 75, no 6, p. 1336-1347Article in journal (Refereed)
    Abstract [en]

    Objectives: Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age.

    Method: Longitudinal linked Finnish registry data (1988-2007) from 137,653 men and women aged 50-79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models.

    Results: Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50-69 years at baseline, but converge among those aged 70-79 years at baseline.

    Discussion: The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age.

  • 27. Hu, Yaoyue
    et al.
    Leinonen, Taina
    van Hedel, Karen
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    The relationship between living arrangements and higher use of hospital care at middle and older ages: to what extent do observed and unobserved individual characteristics explain this association?2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, article id 1011Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain this association.

    Methods: Longitudinal Finnish registry data for men and women aged 50-89years were used for the period 1987-2007. The relationship between living arrangements (based on whether an individual lived with a partner, other adults or alone, and whether they lived with minor/adult children) and heavy hospital care use (i.e., having been in hospital for 8 or more days in a year) was studied. First, we applied logistic regression models and linear probability models controlling for observed time-invariant factors (socioeconomic status measured by education, labour force status, and household income; and marital status), and then individual linear probability models with fixed-effects to further account for unobserved time-invariant individual characteristics in the measurement period. Analyses were done separately for 10year age-groups.

    Results: In the logistic regression models, men and women who lived alone had higher crude odds of heavy hospital care use than those living only with their partner. These odds ratios were highest for men and women in the youngest age category (50-59years, 1.72 and 1.36 respectively) and decreased with age. Adjusting for observed time-invariant socioeconomic status attenuated these odds by 14-40%, but adjusting for marital status did not affect the results. Lower odds were observed among adults aged 50-59years who lived with their partner and (minor or adult) children. But odds were higher for individuals aged 60-79years who co-resided with their adult children, regardless of whether they lived with a partner. Adjusting for observed time-invariant factors generally did not change these results. After further adjusting for unobserved time-invariant individual characteristics in the individual fixed-effects models, most of these associations largely attenuated or disappeared, particularly for ages 80-89years.

    Conclusions: The association between living arrangements and higher use of hospital care at middle and older ages is largely explained by socioeconomic disadvantage and unobserved time-invariant individual characteristics.

  • 28. Hu, Yaoyue
    et al.
    Ruiz, Milagros
    Bobak, Martin
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Do multigenerational living arrangements influence depressive symptoms in mid-late life? Cross-national findings from China and England2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 277, p. 584-591Article in journal (Refereed)
    Abstract [en]

    Background: While living alone predicts depression in diverse ageing populations, the impact of multi-generational living is unclear. This study compared mid-late life depressive symptoms by living arrangements between societies with distinct kinship ties.

    Methods: Repeated data on depressive symptoms and living arrangements over 4 years from 16,229 Chinese (age >= 45) and 10,403 English adults (age >= 50) were analyzed using multilevel mixed-effects logistic regression. Elevated depressive symptoms were identified using the Center for Epidemiological Depression Scale criteria in each study.

    Results: Higher odds ratios (ORs) of elevated depressive symptoms were found in both Chinese and English adults aged<60 living with no partner but with children/grandchildren, compared to those living with a partner only. These ORs were greater for men (Chinese men: 3.09, 95% confidence interval: 2.00-4.78; English men: 3.44, 1.36-8.72) than for women (Chinese women: 1.77, 1.23-2.56; English women: 2.88, 1.41-3.67), after controlling for socioeconomic position, health behaviors, and health status. This male disadvantage was also observed for English, but not for Chinese, adults aged<60 living alone. For adults aged 60+, the increased odds among those living with no partner but with children/grandchildren and those living alone were smaller in both countries.

    Limitations: Bias may exist because depressed participants are more likely to experience divorce or separation prior to baseline.

    Conclusions: The relationship between living arrangements and depressive symptoms appears robust and consistent across social contexts, although the mechanisms differ. The protective role of partners in both China and England supports targeting those who do not live with partners to reduce depression.

  • 29. Hu, Yaoyue
    et al.
    Ruiz, Milagros
    Bobak, Martin
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Four-year trajectories of episodic memory decline in mid-late life by living arrangements: a cross-national comparison between China and England2021In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 75, no 9, p. 881-889Article in journal (Refereed)
    Abstract [en]

    Background There is mixed evidence on the association between living arrangements and mid-late life cognition, which may be due to distinct familial arrangements and preferences between populations. To address such heterogeneity, we assessed these associations in China and England.

    Methods Four-year trajectories of episodic memory scores (0–20, word recall test) by living arrangements (living with partner only, living with partner and children/grandchildren, living with no partner but with children/grandchildren, and living alone) were estimated using latent growth curve modelling for men and women aged 50+ from China (n=12 801) and England (n=10 964).

    Results After adjusting for baseline socioeconomic, health behaviours and health covariates, worse baseline memory was found in Chinese adults living with no partner but with children/grandchildren and in Chinese women living with partner and children/grandchildren, compared with those living with partner only. Better baseline memory was associated with living alone in English women. A faster memory decline was found in Chinese men living with no partner but with children/grandchildren (−0.122 word/year, 95% CI −0.213 to –0.031), as well as in English women living with children/grandchildren with (−0.114, 95% CI −0.180 to –0.049) or without (−0.118, 95% CI −0.209 to –0.026) a partner, and those living alone (−0.075, 95% CI −0.127 to –0.024). No differences at baseline nor over follow-up were found between English men in different living arrangements.

    Conclusion Overall, our findings did not confirm the protective effects of co-residence with children/grandchildren, nor the detrimental effects of living alone on mid-late life cognition in China and England.

  • 30. Junna, Liina M.
    et al.
    Tarkiainen, Lasse
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Jasilionis, Domantas
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Exploring the longevity advantage of doctorates in Finland and Sweden: The role of smoking- and alcohol-related causes of death2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 4, p. 419-422Article in journal (Refereed)
    Abstract [en]

    Aims: Tobacco smoking and alcohol use contribute to differences in life expectancy between individuals with primary, secondary and tertiary education. Less is known about the contribution of these risk factors to differences at higher levels of education. We estimate the contribution of smoking and alcohol use to the life-expectancy differences between the doctorates and the other tertiary-educated groups in Finland and in Sweden. Methods: We used total population data from Finland and Sweden from 2011 to 2015 to calculate period life expectancies at 40 years of age. We present the results by sex and educational attainment, the latter categorised as doctorate or licentiate degrees, or other tertiary. We also present an age and cause of death decomposition to assess the contribution of deaths related to smoking and alcohol. Results: In Finland, deaths related to smoking and alcohol constituted 48.6% of the 2.1-year difference in life expectancy between men with doctorate degrees and the other tertiary-educated men, and 22.9% of the 2.1-year difference between women, respectively. In Sweden, these causes account for 22.2% of the 1.9-year difference among men, and 55.7% of the 1.6-year difference among women, which in the latter case is mainly due to smoking. Conclusions: Individuals with doctorates tend to live longer than other tertiary-educated individuals. This difference can be partly attributed to alcohol consumption and smoking.

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  • 31. Junna, Liina
    et al.
    Moustgaard, Heta
    Huttunen, Kristiina
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    The Association Between Unemployment and Mortality: A Cohort Study of Workplace Downsizing and Closure2020In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 189, no 7, p. 698-707Article in journal (Refereed)
    Abstract [en]

    Workplace downsizing and closure have been considered natural experiments that strengthen causal inference when assessing the association between unemployment and health. Selection into unemployment plays a lesser role among those exposed to severe workplace downsizing. This study compared mortality for individuals unemployed from stable, downsized, and closed workplaces with a reference group unexposed to unemployment. We examined nationally representative register data of residents of Finland aged 25-63 years in 1990-2009 (n = 275,738). Compared with the control group, the hazard ratio for substance use-related mortality among men unemployed from stable workplaces was 2.43 (95% confidence interval (CI): 2.22, 2.67), from downsized workplaces 1.85 (CI: 1.65, 2.08), and from closed workplaces 2.16 (CI: 1.84, 2.53). Among women, the corresponding estimates were 3.01 (CI: 2.42, 3.74), 2.39 (CI: 1.75, 3.27), and 1.47 (CI: 1.09, 1.99). Unemployment from stable workplaces was associated with mortality from psychiatric and self-harm-related conditions. However, mortality due to ischemic heart disease and other somatic diseases decreased for those unemployed following closure. The results indicate that selection mechanisms partially explain the excess mortality among the unemployed. However, substance-use outcomes among men and women, and fatal accidents and violence among men, might be causally associated with unemployment.

  • 32. Junna, Liina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Health-related selection into employment among the unemployed2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 657Article in journal (Refereed)
    Abstract [en]

    Background: Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability.

    Methods: Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders.

    Results: The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment.

    Conclusions: The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

  • 33. Junna, Liina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Unemployment from stable, downsized and closed workplaces and alcohol-related mortality2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 1, p. 74-82Article in journal (Refereed)
    Abstract [en]

    Aims To assess the importance of health selection in the association between unemployment and alcohol-related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection. Design We estimated hazards models of unemployment on alcohol-related diseases and poisonings and external causes with alcohol as a contributing cause over follow-ups of 0-5, 6-10 and 11-20 years and at different levels of downsizing (stable, downsized or closed). Setting Finland, 1990 to 2009. Participants A register-based random sample of employees aged 25-63 in privately owned workplaces (n = 275 738). Measurements The outcome was alcohol-related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate. Findings Alcohol-disease mortality was elevated among the unemployed throughout the follow-up, regardless of the level of downsizing. At 11-20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14-2.82), those from downsized workplaces 1.94 (95% CI = 1.64-2.30) and those from closed workplaces 2.13 (95% CI = 1.75-2.59), when compared with the controls. Alcohol-related external-cause mortality at 0-5 years follow-up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22-1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11-20-year follow-up, the HR following downsizing was 1.83 (CI 95% = 1.37-2.45) and 1.54 (95% CI = 1.03-2.28) following closure. Conclusions There is some indication that alcohol-related ill-health may lead to unemployment in Finland. However, the persistent long-term association between unemployment and alcohol-related mortality even after workplace closure may imply a causal relation.

  • 34. Junna, Liina
    et al.
    Moustgaard, Heta
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    The Association Between Income and Psychotropic Drug Purchases: Individual Fixed Effects Analysis of Annual Longitudinal Data in 2003-20132019In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 30, no 2, p. 221-229Article in journal (Refereed)
    Abstract [en]

    Background: Previous cross-sectional studies show that low income is associated with poor mental health. However, longitudinal research has produced varying results. We assess whether low income is associated with increased psychotropic drug use after accounting for confounding by observed time-varying, and unobserved stable individual differences. Methods: The longitudinal register-based data comprises an 11% nationally representative random sample of Finnish residents aged 30-62 years between the years 2003 and 2013. The analytic sample includes 337,456 individuals (2,825,589 person-years). We estimate the association between annual income and psychotropic purchasing using ordinary-least-squares and fixed effects models, the latter controlling for all unobserved time-invariant individual characteristics. Results: The annual prevalence of psychotropic purchasing was 15%; 13% among men and 18% among women. Adjusted for age squared, sex and calendar year, the doubling of income decreased the probability of purchases by 4 percentage points (95% confidence interval: 4,4) in the ordinary-least-squares model. We observed no association after further adjusting for observed sociodemographic characteristics and unobserved individual differences in the fixed effects specification. Conclusions: Following adjustment for an extensive set of confounders, no contemporaneous association between variations in annual individual income and psychotropic drug purchasing was observed. Similar results were obtained irrespective of baseline income level and sex. The results imply that indirect selection based on preexisting individual characteristics plays a major role in explaining the association between variations in income measured over the short term, and psychotropic drug purchases. The association appears largely attributable to unobserved, stable individual characteristics. See video abstract at, http://links.lww.com/EDE/B463.

  • 35. Kilpi, Fanny
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Konttinen, Hanna
    Silventoinen, Karri
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Kawachi, Ichiro
    Reply to Oude Groeniger and van Lenthe2018In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 29, no 4, p. e37-e37Article in journal (Other academic)
  • 36. Kilpi, Fanny
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Konttinen, Hanna
    Silventoinen, Karri
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Kawachi, Ichiro
    The Spillover Influence of Partner’s Education on Myocardial Infarction Incidence and Survival2018In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 29, no 2, p. 237-245Article in journal (Refereed)
    Abstract [en]

    Background: Education is believed to have positive spillover effects across network connections. Partner’s education may be an important resource preventing the incidence of disease and helping patients cope with illness. We examined how partner’s education predicted myocardial infarction (MI) incidence and survival net of own education and other socioeconomic resources in Finland.

    Methods: A sample of adults aged 40–69 years at baseline in Finland in 1990 was followed up for MI incidence and mortality during the period 1991–2007 (n = 354,100).

    Results: Lower own and spousal education both contributed independently to a higher risk of MI incidence and fatality when mutually adjusted. Having a partner with basic education was particularly strongly associated with long-term fatality in women with a hazard ratio of 1.53 (95% confidence interval, 1.22–1.92) compared with women with tertiary level educated partners. There was some evidence that the incidence risk associated with basic spousal education was weaker in those with own basic education. The highest risks of MI incidence and fatality were consistently found in those without a partner, whereas the most favorable outcomes were in households where both partners had a tertiary level of education.

    Conclusions: Accounting for spousal education demonstrates how health-enhancing resources accumulate to some households. Marriage between people of similar educational levels may therefore contribute to the widening of educational differences in MI incidence and survival.

  • 37. Kilpi, Fanny
    et al.
    Silventoinen, Karri
    Konttinen, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300 000 Finnish adults2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 2, p. 260-266Article in journal (Refereed)
    Abstract [en]

    Background: Lower socioeconomic position (SEP) is associated with an increased risk of myocardial infarction (MI) incidence and mortality, but the relative importance of different socioeconomic resources at different stages of the disease remains unclear. Methods: A nationally representative register-based sample of 40- to 60-year-old Finnish men and women in 1995 (n = 302 885) were followed up for MI incidence and mortality in 1996-2007. We compared the effects of education, occupation, income and wealth on first MI incidence, first-day and long-term fatality. Cox's proportional hazards regression and logistic regression models were estimated adjusting for SEP covariates simultaneously to assess independent effects. Results: Fully adjusted models showed greatest relative inequalities of MI incidence by wealth in both sexes, with an increased risk also associated with manual occupations. Education was a significant predictor of incidence in men. Low income was associated with a greater risk of death on the day of MI incidence [odds ratio (OR) = 1.40 in men and 1.95 in women when comparing lowest and highest income quintiles], and in men, with long-term fatality [hazard ratio (HR) = 1.74]. Wealth contributed to inequalities in first-day fatality in men and in long-term fatality in both sexes. Conclusion: The results show that different socioeconomic resources have diverse effects on the disease process and add new evidence on the significant association of wealth with heart disease onset and fatality. Targeting those with the least resources could improve survival in MI patients and help reduce social inequalities in coronary heart disease mortality.

  • 38. Kilpi, Fanny
    et al.
    Silventoinen, Karri
    Konttinen, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute of Demographic Research, Germany.
    Early-life and adult socioeconomic determinants of myocardial infarction incidence and fatality2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 177, p. 100-109Article in journal (Refereed)
    Abstract [en]

    Social inequalities in coronary heart disease mortality have roots in childhood conditions, but it is unknown whether they are associated both with the incidence of the disease and the following survival. We studied how several different early-life socioeconomic factors, together with later socioeconomic attainment, were associated with myocardial infarction (MI) incidence and fatality in Finland. The data was based on a register-based sample of households from a census in 1950 that also provided information on childhood circumstances. MI hospitalizations and mortality in 1988-2010 were studied in those who were up to 14 years of age at the time of the census and resident in Finland in 1987 (n = 94,501). Parental education, occupation, household crowding, home ownership, and family type were examined together with adulthood education and income. Hazard and odds ratios with 95% confidence intervals (CI) were calculated using Cox regression (incidence and long-term fatality) and logistic regression (short-term fatality) models. Lower parental education, occupational background and greater household crowding were associated with MI incidence. In models adjusted for adulthood variables, crowding increased the risk by 16% (95% CI 5-29%) in men and 25% (95% CI 3-50%) in women. Shortterm survival was more favourable in sons of white-collar parents and daughters of owner-occupied households, but most aspects of childhood circumstances did not strongly influence long-term fatality risk. Socioeconomic attainment in adulthood accounted for a substantial part of the effects of childhood conditions, but the measured childhood factors explained little of the disparities by adulthood education and income. Moreover, income and education remained associated with MI incidence when adjusted for unobserved shared family factors in siblings. Though social and economic development in society seems to have mitigated the disease burden associated with poor childhood living conditions in Finland, low adult socioeconomic resources have remained a strong determinant of MI incidence and fatality.

  • 39. Konttinen, Hanna
    et al.
    Kilpi, Fanny
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Socioeconomic Position and Antidepressant Use as Predictors of Coronary Heart Disease Mortality: A Population-Based Registry Study of 362,271 Finns2016In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 78, no 2, p. 144-152Article in journal (Refereed)
    Abstract [en]

    Objective: The interplay between depression and socioeconomic position (SEP) in predicting cardiovascular outcomes has rarely been examined. We investigated whether SEP modified the effect of antidepressant use on coronary heart disease (CHD) mortality.

    Methods: The data consisted of an 11% random sample of the Finnish population aged 40 to 79 years at the end of 1999 with an oversample of 80% of those who died in 2000 to 2007. Participants free of CHD at baseline (n = 362,271) were followed up for CHD mortality in 2000 to 2007. SEP was assessed via registry-based information on education, occupational position, and income. Antidepressant use served as a proxy for depression and was derived from registry data on prescription medication purchases in the 5-year period preceding baseline. Age- and sex-adjusted Cox regression models with sampling weights were used.

    Results: Individuals with antidepressant purchases in any year 1995 to 1999 had a higher risk of CHD deaths (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.62-1.75) than did those without purchases. Basic level of education (HR = 2.09, 95% CI = 2.01-2.17), blue-collar occupations (HR = 1.70, 95% CI = 1.65-1.75), and the lowest income tertile (HR = 2.79, 95% CI = 2.69-2.91) were related to increased relative risks for CHD mortality. No significant (p < .05) interactions emerged between the SEP indicators and antidepressant purchases indicating that the effect of antidepressant use on the relative risk for CHD was similar across varying levels of SEP.

    Conclusions: Our study demonstrates that in a country with tax-funded universal health care services, low SEP does not exacerbate the adverse effects of depressionas measured by antidepressant treatmenton cardiovascular health.

  • 40. Korhonen, Kaarina
    et al.
    Einiö, Elina
    Leinonen, Taina
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 1, article id e033234Article in journal (Refereed)
    Abstract [en]

    Objectives To assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages.

    Design Prospective population-based register study.

    Setting Finland.

    Participants 11% random sample of the population aged 70-87 years resident in Finland at the end of year 2000 (n=54 964).

    Main outcome measure Incidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001-2016 by midlife education, occupational social class and household income measured at ages 53-57 years.

    Results During the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained.

    Conclusion Several indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.

  • 41. Korhonen, Kaarina
    et al.
    Einiö, Elina
    Leinonen, Taina
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Time-varying effects of socio-demographic and economic factors on the use of institutional long-term care before dementia-related death: A Finnish register-based study2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199551Article in journal (Refereed)
    Abstract [en]

    Objectives The effects of socio-demographic and economic factors on institutional long-term care (LTC) among people with dementia remain unclear. Inconsistent findings may relate to time varying effects of these factors as dementia progresses. To clarify the question, we estimated institutional LTC trajectories by age, marital status and household income in the eight years preceding dementia-related and non-dementia-related deaths. Methods We assessed a population-representative sample of Finnish men and women for institutional LTC over an eight-year period before death. Deaths related to dementia and all other causes at the age of 70+ in 2001-2007 were identified from the Death Register. Dates in institutional LTC were obtained from national care registers. We calculated the average and time-varying marginal effects of age, marital status and household income on the estimated probability of institutional LTC use, employing repeated-measures logistic regression models with generalised estimating equations (GEE). Results The effects of age, marital status and household income on institutional LTC varied across the time before death, and the patterns differed between dementia-related and non-dementia-related deaths. Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared. Among women in particular, the probability of institutional LTC was nearly equal across age, marital status and income groups in the last year before dementia-related death. Among those who died from non-dementia-related causes, in contrast, the differences widened until death. Conclusions We show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources. The results imply that the potential for extending community living for people with dementia is likely to be difficult through modification of their socio-demographic and economic environments.

  • 42. Korhonen, Kaarina
    et al.
    Leinonen, Taina
    Tarkiainen, Lasse
    Einiö, Elina
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany.
    Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators2022In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 52, no 2, p. 523-535Article in journal (Refereed)
    Abstract [en]

    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.

  • 43. Korhonen, Kaarina
    et al.
    Moustgaard, Heta
    Tarkiainen, Lasse
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Costa, Giuseppe
    Urhoj, Stine Kjaer
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy2021In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 295, p. 831-838Article in journal (Refereed)
    Abstract [en]

    Background: The reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries.

    Methods: Using register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death.

    Results: The life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, 'other diseases' (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years.

    Limitations: The indication of antidepressant prescription could not be ascertained from the medication registers.

    Conclusions: Interventions should be directed to self-harm and substance use problems among younger psychi-atric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.

  • 44. Korhonen, Kaarina
    et al.
    Remes, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Education as a social pathway from parental socioeconomic position to depression in late adolescence and early adulthood: a Finnish population-based register study2017In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 52, no 1, p. 105-116Article in journal (Refereed)
    Abstract [en]

    There is inconsistent evidence for social differentials in the risk of depression in youth, and little is known about how education at this age influences the risk. We assess how parental socioeconomic position (SEP) and education predict depression from late adolescence to early adulthood, a time of major educational transitions. We followed a nationally representative 20 % sample of Finnish adolescents born in 1986-1990 (n = 60,829) over two educational transitory stages at the age of 17-19 and 20-23 covering the years 2003-2011. We identified incident depression using health care register data. We estimated the risk of depression by parental SEP and personal education using Cox regression, adjusting for family structure, parental depression and the individual's own psychiatric history. Lower parental income was associated with up to a twofold risk of depression. This effect was almost fully attributable to other parental characteristics or mediated by the individual's own education. Educational differences in risk were attenuated following adjustment for prior psychiatric history. Adjusted for all covariates, not being in education increased the risk up to 2.5-fold compared to being enrolled in general upper secondary school at the age of 17-19 and in tertiary education at the age of 20-23. Vocationally oriented women experienced a 20 % higher risk than their academically oriented counterparts in both age groups. Education constitutes a social pathway from parental SEP to the risk of depression in youth, whereby educational differences previously shown in adults are observed already before the establishment of adulthood SEP.

  • 45. Korhonen, Kaarina
    et al.
    Tarkiainen, Lasse
    Leinonen, Taina
    Einiö, Elina
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Association between a history of clinical depression and dementia, and the role of sociodemographic factors: population-based cohort study2022In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 221, no 1, p. 410-416Article in journal (Refereed)
    Abstract [en]

    Background

    Depression is associated with an increased dementia risk, but the nature of the association in the long-term remains unresolved, and the role of sociodemographic factors mainly unexplored.

    Aims

    To assess whether a history of clinical depression is associated with dementia in later life, controlling for observed sociodemographic factors and unobserved factors shared by siblings, and to test whether gender, educational level and marital status modify the association.

    Method

    We conducted a national cohort study of 1 616 321 individuals aged 65 years or older between 2001 and 2018 using administrative healthcare data. A history of depression was ascertained from the national hospital register in the period 15–30 years prior to dementia follow-up. We used conventional and sibling fixed-effects Cox regression models to analyse the association between a history of depression, sociodemographic factors and dementia.

    Results

    A history of depression was related to an adjusted hazard ratio of 1.27 (95% CI 1.23–1.31) for dementia in the conventional Cox model and of 1.55 (95% CI 1.09–2.20) in the sibling fixed-effects model. Depression was related to an elevated dementia risk similarly across all levels of education (test for interaction, P = 0.84), but the association was weaker for the widowed than for the married (P = 0.003), and stronger for men than women (P = 0.006). The excess risk among men attenuated following covariate adjustment (P = 0.10).

    Discussion

    This study shows that a history of depression is consistently associated with later-life dementia risk. The results support the hypothesis that depression is an aetiological risk factor for dementia.

  • 46. Kröger, Hannes
    et al.
    Hoffmann, Rasmus
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Comparing Observed and Unobserved Components of Childhood: Evidence From Finnish Register Data on Midlife Mortality From Siblings and Their Parents2018In: Demography, ISSN 0070-3370, E-ISSN 1533-7790, Vol. 55, no 1, p. 295-318Article in journal (Refereed)
    Abstract [en]

    In this study, we argue that the long arm of childhood that determines adult mortality should be thought of as comprising an observed part and its unobserved counterpart, reflecting the observed socioeconomic position of individuals and their parents and unobserved factors shared within a family. Our estimates of the observed and unobserved parts of the long arm of childhood are based on family-level variance in a survival analytic regression model, using siblings nested within families as the units of analysis. The study uses a sample of Finnish siblings born between 1936 and 1950 obtained from Finnish census data. Individuals are followed from ages 35 to 72. To explain familial influence on mortality, we use demographic background factors, the socioeconomic position of the parents, and the individuals' own socioeconomic position at age 35 as predictors of all-cause and cause-specific mortality. The observed part-demographic and socioeconomic factors, including region; number of siblings; native language; parents' education and occupation; and individuals' income, occupation, tenancy status, and education-accounts for between 10 % and 25 % of the total familial influence on mortality. The larger part of the influence of the family on mortality is not explained by observed individual and parental socioeconomic position or demographic background and thus remains an unobserved component of the arm of childhood. This component highlights the need to investigate the influence of childhood circumstances on adult mortality in a comprehensive framework, including demographic, social, behavioral, and genetic information from the family of origin.

  • 47. Kühn, Mine
    et al.
    Metsä-Simola, Niina
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland .
    Pathways into single motherhood, re-partnering, and trajectories of antidepressant medication purchases2023In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 58, no 3, p. 409-420Article in journal (Refereed)
    Abstract [en]

    Single motherhood is known to be distressing, and to be associated with poor mental health. However, less is known about the pathways into and out of single motherhood, or about the mental health trajectories of single mothers. We used total population registry data on Finnish women who experienced the life events of separation (616,762), widowhood (43,355), or child birth (515,756) during the 1995–2018 period while between the ages of 15–64. Single mothers were compared with women who experienced the same life event, but without becoming a single mother. The results for women who separated showed that among single mothers, there was a substantial increase in antidepressant use at the time of separation, and only a moderate decline after separation. Among women who experienced widowhood, those who had underage children initially had lower antidepressant use than women without children, but this gap narrowed in the post-widowhood period. In addition, single women experienced more unfavorable mental health trajectories than partnered women around the time they gave birth. Re-partnering was associated with more favorable mental health among all groups of single mothers. Given the growing prevalence of single-parent households, our results underscore the need for context-specific interventions to support single mothers’ mental health. 

  • 48. Lahtinen, Hannu
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Mattila, Mikko
    Wass, Hanna
    Rapeli, Lauri
    Do Surveys Overestimate or Underestimate Socioeconomic Differences in Voter Turnout? Evidence from Administrative Registers2019In: Public Opinion Quarterly, ISSN 0033-362X, E-ISSN 1537-5331, Vol. 83, no 2, p. 363-385Article in journal (Refereed)
    Abstract [en]

    Surveys generally overestimate the overall level of voter turnout in elections due to both the misreporting of voting and nonresponse. It is sometimes argued that socioeconomic differences in turnout are exaggerated in surveys because social desirability has a more pronounced effect on eligible voters in more advantaged socioeconomic positions. However, the contribution of nonresponse bias has not been taken into consideration in these assessments. Using a register-linked survey with information on the education, occupational social class, income, and voting in the 2015 Finnish parliamentary elections of both respondents and nonrespondents, this study shows that nonresponse bias leads to not only a larger overestimation of the overall level of turnout than social desirability, but also an underestimation of educational, social class, and income-related differences in the propensity to vote. Socioeconomic differences in the probability of voting in register-based data were at least two-thirds larger than differences obtained when using standard survey techniques. This finding implies that socioeconomic inequality in electoral participation is a more pressing social problem than previous evidence might indicate.

  • 49. Lahtinen, Hannu
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Karolinska Institutet, Sweden; Max Planck Institute for Demographic Research, Germany .
    Tarkiainen, Lasse
    Changes in sibling similarity in education among Finnish cohorts born in 1950–89: the contribution of paternal and maternal education2022In: Longitudinal and Life Course Studies, E-ISSN 1757-9597, Vol. 13, no 4, p. 496-526Article in journal (Refereed)
    Abstract [en]

    Among the many social characteristics that run in the family, education is one of the most strongly persistent. The long-term changes in educational reproduction within families and across generations and the gender-specific drivers of these changes remain partially unclear. Using population data for all Finnish siblings and their parents, we assessed the level of and trends in the intergenerational persistence of education among cohorts born between 1950 and 1989. The variance in education shared among siblings was 37% and remained stable over time. Parental education steadily increased its explanatory power in the shared variance, from 30% among cohorts born in the 1950s to 40% among cohorts born in the 1970s and 1980s. The direct contribution of maternal education net of paternal education for sibling similarity more than doubled across cohorts (from 5% in 1950 to 13% in 1989). The direct contribution of paternal education (10–12%) remained stable. Same-gender siblings resembled each other in education more closely than their opposite-gender counterparts. The growing importance of maternal education over time, which surpasses the predictive power of paternal education, demonstrates an important qualitative change in the determinants of educational stratification. The growing importance of mothers’ education can plausibly result from the strengthening meritocratic achievement of women in education and the associated increase of women in defining the social position of the family. Incorporating the education of both parents in future analyses of intergenerational reproduction of education will probably be increasingly salient.

  • 50. Lahtinen, Hannu
    et al.
    Mattila, Mikko
    Wass, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Explaining Social Class Inequality in Voter Turnout: The Contribution of Income and Health2017In: Scandinavian Political Studies, ISSN 0080-6757, E-ISSN 1467-9477, Vol. 40, no 4, p. 388-410Article in journal (Refereed)
    Abstract [en]

    Occupation-based social class is an important, yet under-explored, factor in electoral participation. In this article, social class differences in voter turnout over time are measured, and how two other resources - namely income and health - mediate or modify this relationship is analysed. The analysis is based on an individual-level register-based 11 percent sample of the entire electorate in the 1999 Finnish parliamentary elections, and secondarily on smaller register-based samples in the 2012 presidential and municipal elections. Results show that income mediates part of the effects of social class on voting, while social class and utilised health indicators exert mainly independent effects on turnout. Social class differences remain largely stable in all income and hospital care groups, except that no differences between classes are observed among those most severely affected by health problems. Results are also mostly similar between those of working age and the older population, and between men and women, and remain stable over time and in different types of elections. The findings imply that social class should be taken account in theoretical and empirical models of turnout.

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