Browsing by Subject "INEQUALITIES"

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  • Elovainio, Marko; Hakulinen, Christian; Pulkki-Raback, Laura; Juonala, Markus; Raitakari, Olli T. (2020)
    We modeled early psychosocial risks as a network of interconnected variables to study their associations with later depressive symptoms and cardiometabolic outcomes. The participants were a nationally representative sample of 2580 men and women aged 3-18 years in 1980. Their parents reported the psychosocial risks in 1980, including the following: (1) child-specific life events, (2) parental health behavior, (3) parental socioeconomic status, and (4) parental psychological problems. Adulthood depressive symptoms and cardiometabolic outcomes were measured in 2007-2012. The most central risks (most number of connections to other risks) were socioeconomic risks that also predicted health outcomes more consistently than others.
  • Kivimäki, Mika; Batty, G David; Pentti, Jaana; Shipley, Martin J; Sipilä, Pyry N; Nyberg, Solja T; Suominen, Sakari B; Oksanen, Tuula; Stenholm, Sari; Virtanen, Marianna; Marmot, Michael G; Singh-Manoux, Archana; Brunner, Eric J; Lindbohm, Joni V; Ferrie, Jane E; Vahtera, Jussi (2020)
    Summary Background Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status and temporal sequences in the development of 56 common diseases and health conditions. Methods In this multi-cohort study, we used data from two Finnish prospective cohort studies: the Health and Social Support study and the Finnish Public Sector study. Our pooled prospective primary analysis data comprised 109 246 Finnish adults aged 17–77 years at study entry. We captured socioeconomic status using area deprivation and education at baseline (1998–2013). Participants were followed up for health conditions diagnosed according to the WHO International Classification of Diseases until 2016 using linkage to national health records. We tested the generalisability of our findings with an independent UK cohort study—the Whitehall II study (9838 people, baseline in 1997, follow-up to 2017)—using a further socioeconomic status indicator, occupational position. Findings During 1 110 831 person-years at risk, we recorded 245 573 hospitalisations in the Finnish cohorts; the corresponding numbers in the UK study were 60 946 hospitalisations in 186 572 person-years. Across the three socioeconomic position indicators and after adjustment for lifestyle factors, compared with more advantaged groups, low socioeconomic status was associated with increased risk for 18 (32·1%) of the 56 conditions. 16 diseases formed a cascade of inter-related health conditions with a hazard ratio greater than 5. This sequence began with psychiatric disorders, substance abuse, and self-harm, which were associated with later liver and renal diseases, ischaemic heart disease, cerebral infarction, chronic obstructive bronchitis, lung cancer, and dementia. Interpretation Our findings highlight the importance of mental health and behavioural problems in setting in motion the development of a range of socioeconomically patterned physical illnesses. Policy and health-care practice addressing psychological health issues in social context and early in the life course could be effective strategies for reducing health inequalities. Funding UK Medical Research Council, US National Institute on Aging, NordForsk, British Heart Foundation, Academy of Finland, and Helsinki Institute of Life Science.
  • Mänty, Minna; Kouvonen, Anne; Lallukka, Tea; Lahti, Jouni; Lahelma, Eero; Rahkonen, Ossi (2018)
    Background: Changes in health functioning over different retirement transitions are poorly understood. This study aimed to examine associations between transition into statutory, disability and part-time retirement, and changes in health functioning. Methods: Survey data were collected among ageing employees of the City of Helsinki, Finland, at three phases: (i) (2000-02), (ii) (2007) and (iii) (2012). Physical and mental health functioning were measured using the Short-Form 36 questionnaire at each phase. Retirees between phases 1 and 3 were identified from the national registers of the Finnish Centre for Pensions: full-time statutory retirement (n = 1464), part-time retirement (n = 404), and disability retirement (n = 462). Generalized estimating equations were used to examine the associations. Results: Disability retirees had poorer pre-and post-retirement health functioning compared to statutory and part-time retirees. Statutory and part-time retirement were associated with no or only small changes in physical health functioning during retirement transition (beta 0.1, 95% CI - 0.3 to 0.5 and -1.0, -1.8 to -0.1, respectively), whereas a clear decline in functioning was observed among disability retirees (-4.3, -5.4 to -3.2). Mental health functioning improved during the retirement transition among statutory and part-time retirees (1.9, 1.4-2.4 and 2.0, 1.0-3.0, respectively), whereas no change was observed for disability retirees. Conclusions: Transition to disability retirement led to a decrease in physical health functioning, and statutory retirement to a slight improvement in mental health functioning. Evidence on changes in physical and mental health functioning during retirement transition process may provide useful information for interventions to promote healthy ageing.
  • Lumme, Sonja; Manderbacka, Kristiina; Arffman, Martti; Karvonen, Sakari; Keskimaki, Ilmo (2020)
    Objectives To study the interplay between several indicators of social disadvantage and hospitalisations due to ambulatory care-sensitive conditions (ACSC) in 2011-2013. To evaluate whether the accumulation of preceding social disadvantage in one point of time or prolongation of social disadvantage had an effect on hospitalisations due to ACSCs. Four common indicators of disadvantage are examined: living alone, low level of education, poverty and unemployment. Design A population-based register study. Setting Nationwide individual-level register data on hospitalisations due to ACSCs for the years 2011-2013 and preceding data on social and socioeconomic factors for the years 2006-2010. Participants Finnish residents aged 45 or older on 1 January 2011. Outcome measure Hospitalisations due to ACSCs in 2011-2013. The effect of accumulation of preceding disadvantage in one point of time and its prolongation on ACSCs was studied using modified Poisson regression. Results People with preceding cumulative social disadvantage were more likely to be hospitalised due to ACSCs. The most hazardous combination was simultaneously living alone, low level of education and poverty among the middle-aged individuals (aged 45-64 years) and the elderly (over 64 years). Risk ratio (RR) of being hospitalised due to ACSC was 3.16 (95% CI 3.03-3.29) among middle-aged men and 3.54 (3.36-3.73) among middle-aged women compared with individuals without any of these risk factors when controlling for age and residential area. For the elderly, the RR was 1.61 (1.57-1.66) among men and 1.69 (1.64-1.74) among women. Conclusions To improve social equity in healthcare, it is important to recognise not only patients with cumulative disadvantage but also-as this study shows-patients with particular combinations of disadvantage who may be more susceptible. The identification of these vulnerable patient groups is also necessary to reduce the use of more expensive treatment in specialised healthcare.
  • Bijwaard, Govert E.; Tynelius, Per; Myrskylae, Mikko (2019)
    Education is negatively associated with most major causes of death. Prior work ignores the premise that cause-specific hazards are interdependent and that both education and mortality depend on cognitive ability. We analyse Swedish men aged 18-63, focusing on months lost due to specific causeswhich solves the interdependence problemand use a structural model that accounts for confounding due to cognitive ability. In a standard Cox model controlling for Intelligence Quotient, improving education is associated with large decreases in mortality for major causes of death. In the structural model, improving education is associated with a small decrease in months lost for most causes and education levels. Among the least educated, however, improving education strongly reduces the months lost, mainly those lost from external causes, such as accidents and suicide. Results suggest that conventional analysis of education and mortality may be biased, even if accounting for observed cognition.
  • Bijwaard, Govert E.; Myrskylä, Mikko; Tynelius, Per; Rasmussen, Finn (2017)
    A negative educational gradient has been found for many causes of death. This association may be partly explained by confounding factors that affect both educational attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors using an innovative method based on months lost due to a specific cause of death re-weighted by the probability of attaining a higher educational level. We use data on men with brothers from the Swedish Military Conscription Registry (1951-1983), linked to administrative registers. This dataset of some 700,000 men allows us to distinguish between five education levels and many causes of death. The empirical results reveal that raising the educational level from primary to tertiary would result in an additional 20 months of survival between ages 18 and 63. This improvement in mortality is mainly attributable to fewer deaths from external causes. The highly educated gain more than nine months due to the reduction in deaths from external causes, but gain only two months due to the reduction in cancer mortality and four months due to the reduction in cardiovascular mortality. Ignoring confounding would lead to an underestimation of the gains by educational attainment, especially for the less educated. Our results imply that if the education distribution of 50,000 Swedish men from the 1951 cohort were replaced with that of the corresponding 1983 cohort, 22% of the person-years that were lost to death between ages 18 and 63 would have been saved for this cohort. (C) 2017 Elsevier Ltd. All rights reserved.
  • Nordentoft, Mads; Rod, Naja H.; Bonde, Jens Peter; Bjorner, Jakob B.; Madsen, Ida E. H.; Pedersen, Line R. M.; Cleal, Bryan; Hanson, Linda L. Magnusson; Nexo, Mette A.; Pentti, Jaana; Stenholm, Sari; Sterud, Tom; Vahtera, Jussi; Rugulies, Reiner (2020)
    Objective: To examine the prospective relation between effort-reward imbalance at work and risk of type 2 diabetes. Methods: We included 50,552 individuals from a national survey of the working population in Denmark, aged 30-64 years and diabetes-free at baseline. Effort-reward imbalance was defined, in accordance with the literature, as a mismatch between high efforts at work (e.g. high work pace, time pressure), and low rewards received in return (e.g. low recognition, job insecurity) and assessed as a continuous and a categorical variable. Incident type 2 diabetes was identified in national health registers. Using Cox regression we calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for estimating the association between effort-reward imbalance at baseline and risk of onset of type 2 diabetes during follow-up, adjusted for sex, age, socioeconomic status, cohabitation, children at home, migration background, survey year and sample method. Results: During 136,239 person-years of follow-up (mean = 2.7 years) we identified 347 type 2 diabetes cases (25.5 cases per 10,000 person-years). For each one standard deviation increase of the effort-reward imbalance score at baseline, the fully adjusted risk of type 2 diabetes during follow-up increased by 9% (HR: 1.09, 95% CI: 0.98-1.21). When we used effort-reward imbalance as a dichotomous variable, exposure to effort-reward imbalance was associated with an increased risk of type 2 diabetes with a HR of 1.27 (95% CI: 1.02-1.58). Conclusion The results of this nationwide study of the Danish workforce suggest that effort-reward imbalance at work may be a risk factor for type 2 diabetes.
  • Hytonen, Tuomas; Naor, Assaf (2019)
    For every Banach space (Y, parallel to . parallel to(Y)) that admits an equivalent uniformly convex norm we prove that there exists c = c(Y) is an element of(0, infinity) with the following property. Suppose that n is an element of N and that X is an n-dimensional normed space with unit ball B-X. Then for every 1-Lipschitz function f : B-X -> Y and for every epsilon is an element of(0, 1/2] there exists a radius r >= exp (1/epsilon(cn)), a point x is an element of B-X with x + r B-X subset of B-X, and an affine mapping Lambda : X -> Y such that parallel to f (y) - Lambda (y)parallel to(Y)
  • Ruokolainen, Otto; Ollila, Hanna; Lahti, Jouni; Rahkonen, Ossi (2019)
    Background: Socioeconomic differences in smoking and other tobacco use are prevalent in adolescents. Less is known about the association between intergenerational social mobility and tobacco use. Methods: Five waves of national cross-sectional School Health Promotion Study during 2008-2017 in Finland were used, including non-academically and academically oriented adolescents (15-21 years, N = 384,379). The adolescents' educational orientation was compared with the educational track of the parents as a proxy for intergenerational social mobility, which was used as the independent variable in regression models to examine the differences in daily smoking and daily snus use. Results: Smoking declined in all mobility groups over time, but remained more prevalent among non-academically oriented adolescents among boys and girls. Daily snus use among boys increased over time in all mobility groups. Multiple adjusted models showed that upward mobility and downward mobility are differently associated with tobacco use, the latter increasing the probability of tobacco use compared with the stable high group (boys: smoking: OR = 5.24, 95% CI 5.02-5.46; snus use: OR = 1.57, 95% CI 1.50-1.66). In smoking, absolute socioeconomic differences between the mobility groups decreased over time while relative differences increased. In snus use, both absolute and relative differences increased. Conclusions: Adolescent smoking and snus use associate strongly with the adolescent's educational track, irrespective of the social mobility class. Non-academically oriented adolescents have an increased risk of tobacco use. The academic and non-academic orientation should already be taken into account in tobacco use prevention in basic education.
  • Nyberg, Solja T.; Fransson, Eleonor I.; Heikkila, Katriina; Alfredsson, Lars; Casini, Annalisa; Clays, Els; De Bacquer, Dirk; Dragano, Nico; Erbel, Raimund; Ferrie, Jane E.; Hamer, Mark; Joeckel, Karl-Heinz; Kittel, France; Knutsson, Anders; Ladwig, Karl-Heinz; Lunau, Thorsten; Marmot, Michael G.; Nordin, Maria; Rugulies, Reiner; Siegrist, Johannes; Steptoe, Andrew; Westerholm, Peter J. M.; Westerlund, Hugo; Theorell, Tores; Brunner, Eric J.; Singh-Manoux, Archana; Batty, G. David; Kivimaki, Mika (2013)
    Background: Job strain is associated with an increased coronary heart disease risk, but few large-scale studies have examined the relationship of this psychosocial characteristic with the biological risk factors that potentially mediate the job strain - heart disease association. Methodology and Principal Findings: We pooled cross-sectional, individual-level data from eight studies comprising 47,045 participants to investigate the association between job strain and the following cardiovascular disease risk factors: diabetes, blood pressure, pulse pressure, lipid fractions, smoking, alcohol consumption, physical inactivity, obesity, and overall cardiovascular disease risk as indexed by the Framingham Risk Score. In age-, sex-, and socioeconomic status-adjusted analyses, compared to those without job strain, people with job strain were more likely to have diabetes (odds ratio 1.29; 95% CI: 1.11-1.51), to smoke (1.14; 1.08-1.20), to be physically inactive (1.34; 1.26-1.41), and to be obese (1.12; 1.04-1.20). The association between job strain and elevated Framingham risk score (1.13; 1.03-1.25) was attributable to the higher prevalence of diabetes, smoking and physical inactivity among those reporting job strain. Conclusions: In this meta-analysis of work-related stress and cardiovascular disease risk factors, job strain was linked to adverse lifestyle and diabetes. No association was observed between job strain, clinic blood pressure or blood lipids.
  • GBD 2016 Healthcare Access & Qua (2018)
    Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97.1 (95% UI 95.8-98.1) in Iceland, followed by 96.6 (94.9-97.9) in Norway and 96.1 (94.5-97.3) in the Netherlands, to values as low as 18.6 (13.1-24.4) in the Central African Republic, 19.0 (14.3-23.7) in Somalia, and 23.4 (20.2-26.8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1-936) in Beijing to 48.0 (43.4-53.2) in Tibet (a 43.5-point difference), while India saw a 30.8-point disparity, from 64.8 (59.6-68.8) in Goa to 34.0 (30.3-38.1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4.8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20.9-point to 17.0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17.2-point to 20.4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view and subsequent provision of quality health care for all populations. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  • Halonen, Jaana I.; Koskinen, Aki; Varje, Pekka; Kouvonen, Anne; Hakanen, Jari J.; Väänänen, Ari (2018)
    Background: We defined gender-specific profiles of mental ill-health for the main occupational groups using three outcomes; antidepressant use, sickness absence (SA) due to depression, and suicides. We also examined which occupational groups had the highest risk of the outcomes, and compared the importance of their predictors. Methods: From a random register cohort of Finnish working age population, individuals in the six largest occupational groups in 2004 for men and women were included (N = 414 357). We used register data to define the first antidepressant purchase (i.e. use), the first long-term SA spell for depression, and suicide between Jan 1st 2005 and Dec 31st 2014. We assessed the risk of each outcome by occupational group with logistic regression models, and used dominance analysis to compare the relative importance of predictors. Results: In all six occupational groups for women, the prevalence of antidepressant use and SA for depression was higher than in the men's occupational groups. The opposite was observed for suicides. The risk of antidepressant use was lower, but the risk of suicide was 2-times higher among men in low vs. high-skilled occupations. Among women, a lower skill-level was associated with a higher risk of SA due to depression. Gender was the most important predictor of all outcomes. Limitations: We lacked information on history of medication use or health problems prior to follow-up. Conclusions: Gendered occupational status was an underlying factor explaining distinctive mental health profiles in the working population. Occupational class-dependent behavioural patterns related to mental health existed among men.
  • Korhonen, Kaarina; Einiö, Elina; Leinonen, Taina; Tarkiainen, Lasse; Martikainen, Pekka (2020)
    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.
  • Hytönen, Tuomas; Martikainen, Henri; Vuorinen, Emil (2019)
    We prove the mixed-norm LpLq-boundedness of a general class of singular integral operators having a multi-parameter singularity and acting on vector-valued (UMD Banach lattice-valued) functions. Moreover, families of such operators with uniform assumptions are shown to be not only uniformly bounded but R-bounded, a genuinely stronger property that is often needed in applications. Previous results of this nature only dealt with convolution-type or slightly more general paraproduct-free singular integrals. In contrast, our analysis specifically targets the array of different partial paraproducts that arise in the multi-parameter setting by interpreting them as paraproduct-valued one-parameter operators. This new point-of-view provides a conceptual simplification over the existing representation results for multi-parameter operators, which is a key to the proof of the boundedness of these operators.
  • Lagström, Hanna; Halonen, Jaana I.; Kawachi, Ichiro; Stenholm, Sari; Pentti, Jaana; Suominen, Sakari; Kivimäki, Mika; Vahtera, Jussi (2019)
    Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.
  • Silventoinen, Karri; Tatsuse, Takashi; Martikainen, Pekka; Rahkonen, Ossi; Lahelma, Eero; Sekine, Michikazu; Lallukka, Tea (2013)
    Background: Occupational class differences in body mass index (BMI) have been systematically reported in developed countries, but the studies have mainly focused on white populations consuming a Westernized diet. We compared occupational class differences in BMI and BMI change in Japan and Finland.Methods: The baseline surveys were conducted during 1998-1999 among Japanese (n = 4080) and during 2000-2002 among Finnish (n = 8685) public-sector employees. Follow-up surveys were conducted among those still employed, in 2003 (n = 3213) and 2007 (n = 7086), respectively. Occupational class and various explanatory factors were surveyed in the baseline questionnaires. Linear regression models were used for data analysis.Results: BMI was higher at baseline and BMI gain was more rapid in Finland than in Japan. In Finland, baseline BMI was lowest among men and women in the highest occupational class and progressively increased to the lowest occupational class; no gradient was found in Japan (country interaction effect, P = 0.020 for men and P < 0.0001 for women). Adjustment for confounding factors reflecting work conditions and health behavior increased the occupational class gradient among Finnish men and women, whereas factors related to social life had no effect. No statistically significant difference in BMI gain was found between occupational classes.Conclusions: The occupational class gradient in BMI was strong among Finnish employees but absent among Japanese employees. This suggests that occupational class inequalities in obesity are not inevitable, even in high-income societies.
  • Pekkala, Johanna; Blomgren, Jenni; Pietilainen, Olli; Lahelma, Eero; Rahkonen, Ossi (2017)
    Objectives Sickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupational class differences. Design Population-based, repeated cross-sectional study. Setting A 70% random sample of Finns aged between 25 and 63 years in the years 1996-2013. Participants The study focused on 25-to 63 year-old female (n between 572 246 and 690 925) and male (n between 525 698 and 644 425) upper and lower nonmanual and manual workers. Disability and old age pensioners, students, the unemployed, entrepreneurs and farmers were excluded. The analyses covered 2 160 084 persons, that is, 77% of the random sample. For primary and secondary outcome measures, we examined yearly prevalence of over 10 working days long sickness absence by occupational class. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used to assess the magnitude and changes in occupational class differences. Results Compared with mid-1990s, sickness absence prevalence was slightly lower in 2013 in all occupational classes except for female lower non-manual workers. Hierarchical occupational class differences in sickness absence were found. Absolute differences (SII) peaked in 2005 in both women (0.12, 95% CI 0.12 to 0.13) and men (0.15, 95% CI 0.14 to 0.15) but reached the previous level in women by 2009 and decreased modestly in men until 2013. Relative differences narrowed over time (p Conclusions Sickness absence prevalence is currently slightly lower in almost all occupational classes than in the mid-1990s, but occupational class differences have remained large. Ill health and poor working conditions especially in the lower occupational classes should be targeted in order to reduce sickness absence and to achieve longer working lives.
  • Lahelma, Eero; Pietiläinen, Olli; Chandola, Tarani; Hyde, Martin; Rahkonen, Ossi; Lallukka, Tea (2019)
    Background Prior analyses of class differences in health trajectories among employees have often omitted women and transitions to retirement. We examined social class trajectories in physical functioning among Finnish female employees from midlife to retirement age, and whether transitions to retirement modified these trajectories. Methods Data were derived from mail surveys at Phases 1-3 (2000-2012) among employees of the City of Helsinki, Finland, aged 40-60 at baseline (n = 8960, 80% women, response rates 69-83%). We included respondents to any of the Phases 1-3 aged 40-72 (n = 6976). We distinguished higher and lower social classes, and employment statuses, i.e. employed, mandatorily retired and disability-retired. Short Form 36 physical component summary was used to measure physical functioning. Mixed-effect growth curve models were used to assess the association of social class and employment status with functioning over age. Results For employed women, physical functioning deteriorated faster in the lower than in the higher class, with class trajectories widening in ages 40-65. After mandatory retirement, functioning deteriorated in both classes, whereas after disability retirement, functioning improved. Across employment statuses, functioning converged at older ages, and the disability-retired caught up with the better functioning of the employed and mandatorily retired. Employment status modified the trajectories, as among the continuously employed and mandatorily retired women functioning deteriorated, but among the disability-retired, trajectories improved and reached a similar level with employed and mandatorily retired women. Social class inequalities remained in all employment status groups. Conclusions Overall, our results suggest evidence for the cumulative disadvantage model, with accumulating work exposures among lower classes potentially contributing to their trajectories of ill health.
  • Hakulinen, Christian; Mok, Pearl L. H.; Horsdal, Henriette Thisted; Pedersen, Carsten B.; Mortensen, Preben Bo; Agerbo, Esben; Webb, Roger T. (2020)
    Background: Links between parental socioeconomic position during childhood and subsequent risks of developing mental disorders have rarely been examined across the diagnostic spectrum. We conducted a comprehensive analysis of parental income level, including income mobility, during childhood and risks for developing mental disorders diagnosed in secondary care in young adulthood. Methods: National cohort study of persons born in Denmark 1980–2000 (N = 1,051,265). Parental income was measured during birth year and at ages 5, 10 and 15. Follow-up began from 15th birthday until mental disorder diagnosis or 31 December 2016, whichever occurred first. Hazard ratios and cumulative incidence were estimated. Results: A quarter (25.2%; 95% CI 24.8–25.6%) of children born in the lowest income quintile families will have a secondary care-diagnosed mental disorder by age 37, versus 13.5% (13.2–13.9%) of those born in the highest income quintile. Longer time spent living in low-income families was associated with higher risks of developing mental disorders. Associations were strongest for substance misuse and personality disorders and weaker for mood disorders and nxiety/somatoform disorders. An exception was eating disorders, with low parental income being associated with attenuated risk. For all diagnostic categories examined except for eating disorders, downward socioeconomic mobility was linked with higher subsequent risk and upward socioeconomic mobility with lower subsequent risk of developing mental disorders. Conclusions: Except for eating disorders, low parental income during childhood is associated with subsequent increased risk of mental disorders diagnosed in secondary care across the diagnostic spectrum. Early interventions to mitigate the disadvantages linked with low income, and better opportunities for upward socioeconomic mobility could reduce social and mental health inequalities.