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Stickley, A., Leinsalu, M., Ruchkin, V., Oh, H., Narita, Z. & Koyanagi, A. (2019). Attention-deficit/hyperactivity disorder symptoms and perceived mental health discrimination in adults in the general population. European psychiatry, 56, 91-96
Open this publication in new window or tab >>Attention-deficit/hyperactivity disorder symptoms and perceived mental health discrimination in adults in the general population
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2019 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 56, p. 91-96Article in journal (Refereed) Published
Abstract [en]

Background: The experience of discrimination is common in individuals with mental health problems and has been associated with a range of negative outcomes. As yet, however, there has been an absence of research on this phenomenon in adults with attention-deficit/hyperactivity disorder (ADHD). The current study examined the association between ADHD symptoms and mental health discrimination in the general adult population. Methods: The analytic sample comprised 7274 individuals aged 18 and above residing in private households in England that were drawn from the Adult Psychiatric Morbidity Survey, 2007. Information on ADHD was obtained with the Adult ADHD Self-Report Scale (ASRS) Screener. A single-item question was used to assess mental health discrimination experienced in the previous 12 months. Logistic regression analysis was used to examine associations. Results: The prevalence of discrimination increased as ADHD symptoms increased but was especially elevated in those with the most severe ADHD symptoms (ASRS score 18–24). In a multivariable logistic regression analysis that was adjusted for a variety of covariates including common mental disorders, ADHD symptoms (ASRS ≥ 14) were associated with almost 3 times higher odds for experiencing mental health discrimination (odds ratio: 2.81, 95% confidence interval: 1.49–5.31). Conclusion: ADHD symptoms are associated with higher odds for experiencing mental health discrimination and this association is especially elevated in those with the most severe ADHD symptoms. Interventions to inform the general public about ADHD may be important for reducing the stigma and discrimination associated with this disorder in adults. 

Keywords
ADHD, Adult, Discrimination, Epidemiology
National Category
Psychiatry
Identifiers
urn:nbn:se:sh:diva-37426 (URN)10.1016/j.eurpsy.2018.12.004 (DOI)30654318 (PubMedID)2-s2.0-85059847384 (Scopus ID)
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-08Bibliographically approved
Griswold, M. G., Fullman, N., Hawley, C., Arian, N., Zimsen, S. R. M., Tymeson, H. D., . . . Gakidou, E. (2018). Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10152), 1015-1035
Open this publication in new window or tab >>Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
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2018 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10152, p. 1015-1035Article in journal (Refereed) Published
Abstract [en]

Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week.

Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-36502 (URN)10.1016/S0140-6736(18)31310-2 (DOI)000445098800025 ()30146330 (PubMedID)
Note

Funding: Bill & Melinda Gates Foundation

Available from: 2018-10-09 Created: 2018-10-09 Last updated: 2018-12-04Bibliographically approved
Stickley, A. & Leinsalu, M. (2018). Childhood hunger and depressive symptoms in adulthood: findings from a population-based study. Journal of Affective Disorders, 226, 332-338
Open this publication in new window or tab >>Childhood hunger and depressive symptoms in adulthood: findings from a population-based study
2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, p. 332-338Article in journal (Refereed) Published
Abstract [en]

Background: Several studies have linked childhood hunger to an increased risk for later depression. However, as yet, there has been little research on this relation in adults of all ages or whether there are sex differences in this association. The current study examined these issues using data from a national population-based sample.

Methods: Data were analyzed from 5095 adults aged 25–84 collected during the Estonian Health Interview Survey 2006. Information was obtained on the frequency of going to bed hungry in childhood and on depressive symptoms using the Emotional State Questionnaire (EST-Q). Logistic regression analysis was used to examine the association between hunger and depression while controlling for other demographic, socioeconomic and health-related variables.

Results: In a fully adjusted model, going to bed hungry in childhood either sometimes or often was associated with significantly increased odds for adult depressive symptoms. When the analysis was stratified by sex the association was more evident in men where any frequency of childhood hunger was linked to adult depression while only women who had experienced hunger often had higher odds for depressive symptoms in the final model.

Limitations: Data on childhood hunger were retrospectively reported and may have been affected by recall bias. We also lacked information on potentially relevant variables such as other childhood adversities that might have been important for the observed associations.

Conclusion: Childhood hunger is associated with an increased risk for depressive symptoms among adults. Preventing hunger in childhood may be important for mental health across the life course.

Keywords
adult, childhood, depression, hunger, stress
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-33403 (URN)10.1016/j.jad.2017.09.013 (DOI)000414329000045 ()29031183 (PubMedID)2-s2.0-85030995992 (Scopus ID)
Funder
The Foundation for Baltic and East European Studies
Note

Also funded by Estonian Research Council (IUT5-1)

Available from: 2017-09-15 Created: 2017-09-15 Last updated: 2017-11-24Bibliographically approved
Stickley, A., Koyanagi, A., Inoue, Y. & Leinsalu, M. (2018). Childhood hunger and thoughts of death or suicide in older adults. The American journal of geriatric psychiatry, 26(10), 1070-1078
Open this publication in new window or tab >>Childhood hunger and thoughts of death or suicide in older adults
2018 (English)In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 26, no 10, p. 1070-1078Article in journal (Refereed) Published
Abstract [en]

Objective There is little research on the effects of childhood hunger on adult mental health. This study examined the association between childhood hunger and recurrent thoughts of death or suicide in older adults. Design Data were analyzed from adults aged 60 and above collected during the Estonian Health Interview Survey 2006 (N=2455). Retrospective information was obtained on the frequency (never, seldom, sometimes, often) of going to bed hungry in childhood, and on the presence of recurrent thoughts of death or suicide in the past 4 weeks. Multivariate logistic regression analysis was used to examine associations between the variables. Results Experiencing hunger in childhood was common (37.6%) with 14.3% of the respondents stating that they often went to bed hungry. In a univariate analysis going to bed hungry either sometimes or often more than doubled the odds for thoughts of death or suicide. Although adjustment for a range of covariates (including physical diseases and depressive episode) attenuated the associations, in the fully adjusted model going to bed hungry sometimes continued to be associated with significantly increased odds for thoughts of death or suicide in older adults (OR = 1.74, 95% CI = 1.10–2.74; Wald χ2 = 5.7, df = 1, p = 0.017). Conclusion The findings of this study suggest that the effects of childhood hunger may be long lasting and associated with mental health and well-being even in older adults.

Keywords
childhood, hunger, death ideation, suicide ideation, Estonia
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-35774 (URN)10.1016/j.jagp.2018.06.005 (DOI)000445766200010 ()30076079 (PubMedID)2-s2.0-85050695608 (Scopus ID)
Funder
The Foundation for Baltic and East European Studies
Available from: 2018-06-29 Created: 2018-06-29 Last updated: 2018-12-04Bibliographically approved
Leinsalu, M., Reile, R., Vals, K., Petkeviciene, J., Tekkel, M. & Stickley, A. (2018). Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004-2012: a repeated cross-sectional study. BMC Oral Health, 18(1), Article ID 199.
Open this publication in new window or tab >>Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004-2012: a repeated cross-sectional study
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2018 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 18, no 1, article id 199Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to assess trends and inequalities in dental care utilization in Estonia and Lithuania in relation to large-scale macroeconomic changes in 2004-2012.

METHODS: Data on 22,784 individuals in the 20-64 age group were retrieved from nationally representative cross-sectional surveys in 2004, 2006, 2008, 2010 and 2012. Age- and sex-standardized prevalence estimates of past 12-month dental visits were calculated for each study year, stratified by gender, age group, ethnicity, educational level and economic activity. Multivariable logistic regression analysis was used to assess the independent effect of study year and socioeconomic status on dental visits.

RESULTS: The age- and sex-standardized prevalence of dental visits in the past 12 months was 46-52% in Estonia and 61-67% in Lithuania. In 2004-2008, the prevalence of dental visits increased by 5.9 percentage points in both countries and fell in 2008-2010 by 3.8 percentage points in Estonia and 4.6 percentage points in Lithuania. In both countries the prevalence of dental care utilization had increased slightly by 2012, although the increase was statistically insignificant. Results from a logistic regression analysis showed that these differences between study years were not explained by differences in socioeconomic status or oral health conditions. Women, the main ethnic group (only in Estonia), and higher educated and employed persons had significantly higher odds of dental visits in both countries, but the odds were lower for 50-64 year olds in Lithuania.

CONCLUSIONS: In European Union countries with lower national wealth, the use of dental services is sensitive to macroeconomic changes regardless of the extent of public coverage, at the same time, higher public coverage may not relate to lower inequalities in dental care use.

Keywords
Dental care utilization, Education, Employment, Social inequalities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-36883 (URN)10.1186/s12903-018-0665-5 (DOI)000451986500001 ()30509245 (PubMedID)2-s2.0-85057874876 (Scopus ID)
Note

Fundet by the Estonian Research Council (grant no. IUT5–1). 

Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2018-12-20Bibliographically approved
Lozano, R., Leinsalu, M. & Murray, C. J. L. (2018). Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 2091-2138
Open this publication in new window or tab >>Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
2018 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10159, p. 2091-2138Article in journal (Refereed) Published
Abstract [en]

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health -related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. 

Methods We measured progress on 41 health-related S DG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2.5th percentile and 100 as the 97.5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. 

Findings The global median health-related SDG index in 2017 was 59.4 (IQR 35.4-67.3), ranging from a low of 11.6 (95% uncertainty interval 9.6-14.0) to a high of 84.9 (83.1-86.7). SDG index values in countries assessed at the subnational level varied substantially particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attaimnent by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

Interpretation The GBD study offers a unique, robust platform for monitoring the health -related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health -related SDG indicators, NCDs, NCD-related risks, and violence -related indicators will require a concerted shift away from what might have driven past gains curative interventions in the case of NCDs towards multisectoral, prevention -oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the S DGs. What is clear is that our actions or inaction today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. 

National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-36832 (URN)10.1016/S0140-6736(18)32281-5 (DOI)000449710900010 ()
Note

GBD 2017 SDG Collaborators

Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2018-12-04Bibliographically approved
Lorant, V., de Gelder, R., Kapadia, D., Borrell, C., Kalediene, R., Kovács, K., . . . Mackenbach, J. P. (2018). Socioeconomic inequalities in suicide in Europe: the widening gap. British Journal of Psychiatry, 212(6), 356-361
Open this publication in new window or tab >>Socioeconomic inequalities in suicide in Europe: the widening gap
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2018 (English)In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 212, no 6, p. 356-361Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Suicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well.AimsWe assessed recent trends in socioeconomic inequalities in suicide in 15 European populations.

METHOD: The DEMETRIQ study collected and harmonised register-based data on suicide mortality follow-up of population censuses, from 1991 and 2001, in European populations aged 35-79. Absolute and relative inequalities of suicide according to education were computed on more than 300 million person-years.

RESULTS: In the 1990s, people in the lowest educational group had 1.82 times more suicides than those in the highest group. In the 2000s, this ratio increased to 2.12. Among men, absolute and relative inequalities were substantial in both periods and generally did not decrease over time, whereas among women inequalities were absent in the first period and emerged in the second.

CONCLUSIONS: The World Health Organization (WHO) plan for 'Fair opportunity of mental wellbeing' is not likely to be met.Declaration of interestNone.

National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-35349 (URN)10.1192/bjp.2017.32 (DOI)000434294200005 ()29786492 (PubMedID)2-s2.0-85052089564 (Scopus ID)
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-09-11Bibliographically approved
Mackenbach, J. P., Valverde, J. R., Artnik, B., Bopp, M., Brønnum-Hansen, H., Deboosere, P., . . . Nusselder, W. J. (2018). Trends in health inequalities in 27 European countries. Proceedings of the National Academy of Sciences of the United States of America, 115(25), 6440-6445
Open this publication in new window or tab >>Trends in health inequalities in 27 European countries
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2018 (English)In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 115, no 25, p. 6440-6445Article in journal (Refereed) Published
Abstract [en]

Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from <i>ca</i> 1980 to <i>ca</i> 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from <i>ca</i> 2002 to <i>ca</i> 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.

Keywords
Europe, financial crisis, health inequalities, morbidity, mortality
National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-35681 (URN)10.1073/pnas.1800028115 (DOI)000435585200051 ()29866829 (PubMedID)2-s2.0-85048950034 (Scopus ID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2018-12-04Bibliographically approved
Mackenbach, J. P., Bopp, M., Deboosere, P., Kovacs, K., Leinsalu, M., Martikainen, P., . . . de Gelder, R. (2017). Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries. Health and Place, 47, 44-53
Open this publication in new window or tab >>Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries
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2017 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 47, p. 44-53Article in journal (Refereed) Published
Abstract [en]

The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970–2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy.

Keywords
International variations, Mortality, Health inequalities, Determinants, Europe
National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-33074 (URN)10.1016/j.healthplace.2017.07.005 (DOI)000410785700006 ()28738213 (PubMedID)2-s2.0-85024827367 (Scopus ID)
Available from: 2017-07-21 Created: 2017-07-21 Last updated: 2018-06-28Bibliographically approved
Östergren, O., Lundberg, O., Artnik, B., Bopp, M., Borrell, C., Kalediene, R., . . . Mackenbach, J. P. (2017). Educational expansion and inequalities in mortality - A fixed-effects analysis using longitudinal data from 18 European populations. PLoS ONE, 12(8), Article ID e0182526.
Open this publication in new window or tab >>Educational expansion and inequalities in mortality - A fixed-effects analysis using longitudinal data from 18 European populations
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182526Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this paper is to empirically evaluate whether widening educational inequalities in mortality are related to the substantive shifts that have occurred in the educational distribution.

MATERIALS AND METHODS: Data on education and mortality from 18 European populations across several decades were collected and harmonized as part of the Demetriq project. Using a fixed-effects approach to account for time trends and national variation in mortality, we formally test whether the magnitude of relative inequalities in mortality by education is associated with the gender and age-group specific proportion of high and low educated respectively.

RESULTS: The results suggest that in populations with larger proportions of high educated and smaller proportions of low educated, the excess mortality among intermediate and low educated is larger, all other things being equal.

CONCLUSION: We conclude that the widening educational inequalities in mortality being observed in recent decades may in part be attributed to educational expansion.

National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-33171 (URN)10.1371/journal.pone.0182526 (DOI)000408355800027 ()28832601 (PubMedID)2-s2.0-85029230026 (Scopus ID)
Available from: 2017-08-28 Created: 2017-08-28 Last updated: 2017-11-29Bibliographically approved
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