Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition

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Suulamo , U , Tarkiainen , L , Remes , H & Martikainen , P 2021 , ' Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition ' , SSM - Population Health , vol. 15 , 100850 . https://doi.org/10.1016/j.ssmph.2021.100850

Title: Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
Author: Suulamo, Ulla; Tarkiainen, Lasse; Remes, Hanna; Martikainen, Pekka
Contributor: University of Helsinki, Demography
University of Helsinki, Helsinki Institute of Urban and Regional Studies (Urbaria)
University of Helsinki, Demography
University of Helsinki, Helsinki Inequality Initiative (INEQ)
Date: 2021-09
Language: eng
Number of pages: 10
Belongs to series: SSM - Population Health
ISSN: 2352-8273
URI: http://hdl.handle.net/10138/333364
Abstract: Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.
Subject: 5141 Sociology
Mortality
Health inequalities
Regional variation
Long-term trends
Multilevel modelling
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