Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
•The life expectancy among psychiatric inpatients with depression is 12 to 21 years shorter than among people without depression in Denmark, Finland and Sweden, and 6 to 14 years shorter among ...antidepressant-treated outpatients in Turin and Finland.•Unnatural and alcohol-attributable deaths at younger ages contribute most to the shorter life expectancy of psychiatric inpatients with depression.•Unnatural causes at younger ages also contribute to the life expectancy gap among antidepressant-treated outpatient men, especially in Finland.•The shorter life expectancy of antidepressant-treated outpatient women is predominantly attributable to natural deaths at older ages.•The comparison of four countries indicates that the contributions of different causes of death vary according to depression severity and country context, and thus interventions should be tailored accounting for these differentials to be most effective.
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.
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.
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.
The indication of antidepressant prescription could not be ascertained from the medication registers.
Interventions should be directed to self-harm and substance use problems among younger psychiatric 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.
ObjectivesTo 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.DesignProspective population-based register study.SettingFinland.Participants11% random sample of the population aged 70–87 years resident in Finland at the end of year 2000 (n=54 964).Main outcome measureIncidence 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.ResultsDuring 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.ConclusionSeveral 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.
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.
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).
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.
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.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Educational systems that separate students into curriculum tracks later may place less emphasis on socioeconomic family background and allow individuals' personal skills and interests more time to ...manifest. We tested whether postponing tracking from age 11 to 16 results in stronger genetic prediction of education across a population, exploiting the natural experiment of the Finnish comprehensive school reform between 1972 and 1977. The association between polygenic score of education and achieved education strengthened after the reform by one-third among men and those from low-educated families. We observed no evidence for reform effect among women or those from high-educated families. The first cohort experiencing the new system had the strongest increases. From the perspective of genetic prediction, the school reform promoted equality of opportunity and optimal allocation of human capital. The results also suggest that turbulent circumstances, including puberty or ongoing restructuring of institutional practices, may strengthen genetic associations in education.
Married men and women have better health than non-married, but little is known about how cohabitation and marital history are associated with coronary heart disease (CHD) incidence and how these ...associations have changed over time. We analyzed these associations by fitting Cox regression models to register data covering the whole Finnish population aged 35 years or older (N = 4,415,590), who experienced 530,560 first time non-fatal or fatal CHD events during the years 1990–2018. Further, we used stratified Cox regression models to analyze CHD incidence within same-sex sibling pairs (N = 377,730 pairs). Married men and women without previous divorce had the lowest CHD incidence whereas cohabitation and a history of divorce were associated with higher CHD incidence. The associations were stronger in younger (35–64 years old) than older participants (65 years or older). These associations remained after adjusting for several indicators of social position, and the lower CHD incidence among those married without previous divorce was also observed within sibling pairs with a shared family background. The differences in CHD incidence between the categories generally widened over time; the largest and most systematic widening was observed among women in the younger age category. The long standing negative effect of divorce suggests that selection may partly explain the association between partnership status and CHD incidence. Partnership status is an increasingly important factor contributing to social inequalities in health.
•Married men and women without previous divorce history have the lowest CHD risk.•Cohabitation is associated with higher CHD risk than marriage.•The associations between partnership and CHD risk are not explained by social factors.•These associations generally widened over time, especially among women.
The burden of type 2 diabetes (T2D) differs between socioeconomic groups. The present study combines ongoing and plausible trends in T2D incidence and survival by income to forecast future trends in ...cases of T2D and life expectancy with and without T2D up to year 2040. Using Finnish total population data for those aged 30 years on T2D medication and mortality in 1995-2018, we developed and validated a multi-state life table model using age-, gender-, income- and calendar year-specific transition probabilities. We present scenarios based on constant and declining T2D incidence and on the effect of increasing and decreasing obesity on T2D incidence and mortality states up to 2040. With constant T2D incidence at 2019-level, the number of people living with T2D would increase by about 26% between 2020 and 2040. The lowest income group could expect more rapid increases in the number with T2D compared to the highest income group (30% vs. 23% respectively). If the incidence of T2D continues the recent declining trend, we predict about 14% fewer cases. However, if obesity increases two-fold, we predict 15% additional T2D cases. Unless, we reduce the obesity-related excess risk, the number of years lived without T2D could decrease up to 6 years for men in the lowest income group. Under all plausible scenarios, the burden of T2D is set to increase and it will be unequally distributed among socioeconomic groups. An increasing proportion of life expectancy will be spent with T2D.
AbstractObjectiveTo assess the association between area level density of heavy metal bands and cause specific hospital admissions and mortality.DesignLongitudinal register based cohort ...study.Setting311 municipalities in Finland.Participants3 644 944 people aged 15 to 70 residing in Finland at the end of 2001.Main outcome measuresHospital admission and mortality from all causes, internal causes, alcohol attributable causes, accidental injury and violence, suicide or self-harm, and mental health related causes. Appendicitis and toxic effects of metals were negative control outcomes.ResultsDuring 50.4 million person years of follow-up in 2002-17, 4 237 807 person years with hospital admissions were observed and 221 912 individuals died. Mortality in municipalities with a moderate density of heavy metal bands (<5.7 per 10 000 inhabitants) was lower than in municipalities with no heavy metal bands. Hospital admission rates were lower in municipalities with heavy metal bands compared with those with none. These associations could be explained partly by differences in the sociodemographic characteristics of residents in these municipalities. After adjustment for individual characteristics and area level cultural and economic characteristics—proportion of the population with no religious affiliation, unemployment rate, and per capita expenditure on culture and education—large cities with a high density of heavy metal bands (8.2-11.2 per 10 000) showed a mortality advantage (hazard ratio 0.92, 95% confidence interval 0.88 to 0.96). In contrast, the association for hospital admission was fully attenuated (incidence rate ratio 0.99, 95% confidence interval 0.92 to 1.06). The cause specific analysis showed similar results, with the association most pronounced for alcohol attributable mortality (hazard ratio 0.83, 95% confidence interval 0.75 to 0.93 for cities with a high density of heavy metal bands) and alcohol attributable hospital admissions (incidence rate ratio 0.84, 95% confidence interval 0.74 to 0.97 for cities with a high density of heavy metal bands) in the fully adjusted models. No association with heavy metal band density was found for the analysis using appendicitis as a negative control outcome.ConclusionsThe study found no evidence for adverse health outcomes with increasing density of heavy metal bands. Cities with a high density of heavy metal bands showed slightly lower rates of mortality and of hospital admissions for alcohol related problems and self-harm. Although residual confounding remains a problem in observational studies, vibrant local heavy metal scenes—comparable to many other forms of cultural capital—might help to promote health through healthier lifestyles, better coping mechanisms, and a stronger sense of community.
Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life ...expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups.
We analyzed population-register data of all Finns aged ≥65 during 1999-2018 (n=2,016,987) with dates of LTC and death, and sociodemographic characteristics. We estimated transition rates between home, LTC and death using Poisson generalized additive models, and calculated multistate life tables across 1999-2003, 2004-2008, 2009-2013 and 2014-2018.
Between 1999-2003 and 2004-2008, life expectancy in LTC increased from 0.75 (95% CI 0.74-0.76) to 0.89 (0.88-0.90) years among men and from 1.61 (1.59-1.62) to 1.83 (1.81-1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (0.79-0.81) and 1.51 (1.50-1.53) years among men and women, respectively, in 2014-2018. Especially among women and non-married men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time.
Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in ever worse health and spent a shorter time in care than before.
Major changes in the educational distribution of the population and in institutions over the past century have affected the societal barriers to educational attainment. These changes can possibly ...result in stronger genetic associations. Using genetically informed, population-representative Finnish surveys linked to administrative registers, we investigated the polygenic associations and intergenerational transmission of education for those born between 1925 and 1989. First, we found that a polygenic index (PGI) designed to capture genetic predisposition to education strongly increased the predictiveness of educational attainment in pre-1950s cohorts, particularly among women. When decomposing the total contribution of PGI across different educational transitions, the transition between the basic and academic secondary tracks was the most important. This transition accounted for 60–80% of the total PGI–education association among most cohorts. The transition between academic secondary and higher tertiary levels increased its contribution across cohorts. Second, for cohorts born between 1955 and 1984, we observed that one eighth of the association between parental and one's own education is explained by the PGI. There was also an increase in the intergenerational correlation of education among these cohorts, which was partly explained by an increasing association between family education of origin and the PGI.
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