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Title [sv]
Makroekonomiska förändringar och deras påverkan på ojämlikheten i dödlighet: en registerbaserad undersökning av dödlighet i Östersjöländer 2000-2011
Title [en]
Large-scale macroeconomic changes and their impact on inequalities in mortality: a register-based study of mortality in the countries of the Baltic Sea region 2000-2011
Abstract [sv]
Enorma makroekonomiska förändringar har skett i de baltiska länderna under 2000-talet. I detta projekt kommer vi att studera hur en ekonomisk tillväxt utan motstycke från mitten av 2000-talet och den lika stora ekonomiska nedgången efter den globala finanskrisen 2008 har påverkat dödligheten för personer med olika socioekonomiska bakgrund i Estland, Lettland och Litauen. För att bättre kontextualisera resultaten från dessa länder kommer de att jämföras med de från Sverige och Finland för att undersöka möjliga buffrande effekter av en mer ambitiös välfärdspolitik. Information om socioekonomisk status kommer att erhållas från folkräkningar och kommer att kopplas till nationella dödsorsaksregister. Tre perioder kommer att undersökas: 2000-2003, 2004-2007 och 2008-2011. Omfattningen av förändringarna i den totala och orsaksspecifika dödligheten över dessa år kommer att jämföras mellan och inom länderna. Vi fokuserar på alkoholrelaterade dödsorsaker, självmord och dödsorsaker relaterade till medicinsk behandling. De observerade variationerna kommer att tolkas i förhållande till hälso- och socialpolitiken i respektive land. Genom att använda detta unika naturliga experiment för att undersöka effekterna av ekonomiska cykler på människors hälsa i olika sociala grupper, och som det har forskats förhållandevis lite om, kommer projektet bidra till den teoretiska förståelsen av ekonomiska förändringars effekter på hälsan samt belysa hur dess effekter kan variera mellan olika sammanhang.
Abstract [en]
Enormous macroeconomic changes occurred in the Baltic countries in the 2000s. In this project we will study how unprecedented economic growth from the mid-2000s and the equally large economic downturn after the 2008 global financial crisis impacted on the mortality rates of people with different socioeconomic backgrounds in Estonia, Latvia and Lithuania. To better contextualize the findings from these countries they will be compared with those from Sweden and Finland to explore the potential buffering effect of more ambitious welfare policies. Information about demographic and socioeconomic status will be obtained from population censuses and will be linked to national mortality registries to obtain cause of death data. Three distinct periods will be examined: 2000-2003, 2004-2007 and 2008-2011. The magnitude of the changes in overall and cause-specific mortality across these years will be compared between and within the countries. We focus on alcohol-related causes of death, on suicide and causes amenable to medical care. The observed variations will be interpreted in relation to health and social policies in the respective countries. By using this unique natural experiment to explore the effects of economic cycles on human health in diverse social groups that have been comparatively little researched to date, the project will add to the theoretical understanding of how socioeconomic change impacts on health as well as elucidate how its effects can differ between contexts.
Publications (6 of 6) Show all publications
Jasilionis, D. & Leinsalu, M. (2021). Changing effect of the numerator-denominator bias in unlinked data on mortality differentials by education: evidence from Estonia, 2000-2015. Journal of Epidemiology and Community Health, 75(1), 88-91
Open this publication in new window or tab >>Changing effect of the numerator-denominator bias in unlinked data on mortality differentials by education: evidence from Estonia, 2000-2015
2021 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 75, no 1, p. 88-91Article in journal (Refereed) Published
Abstract [en]

Background This study highlights changing disagreement between census and death record information in the reporting of the education of the deceased and shows how these reporting differences influence a range of mortality inequality estimates.

Methods This study uses a census-linked mortality data set for Estonia for the periods 2000–2003 and 2012–2015. The information on the education of the deceased was drawn from both the censuses and death records. Range-type, Gini-type and regression-based measures were applied to measure absolute and relative mortality inequality according to the two types of data on the education of the deceased.

Results The study found a small effect of the numerator–denominator bias on unlinked mortality estimates for the period 2000–2003. The effect of this bias became sizeable in the period 2012–2015: in high education group, mortality was overestimated by 23–28%, whereas the middle education group showed notable underestimation of mortality. The same effect was small for the lowest education group. These biases led to substantial distortions in range-type inequality measures, whereas unlinked and linked Gini-type measures showed somewhat closer agreement.

Conclusions The changing distortions in the unlinked estimates reported in this study warn that this type of evidence cannot be readily used for monitoring changes in mortality inequalities.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
Keywords
Eastern Europe, Education, Inequalities, Measurement, Mortality
National Category
Health Sciences
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-41627 (URN)10.1136/jech-2020-214487 (DOI)000607301500015 ()32699139 (PubMedID)2-s2.0-85094185742 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1Max Planck Society
Available from: 2020-07-28 Created: 2020-07-28 Last updated: 2022-07-12Bibliographically approved
Stickley, A., Baburin, A., Jasilionis, D., Krumins, J., Martikainen, P., Kondo, N. & Leinsalu, M. (2021). Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study. Addiction, 16(12), 3357-3368
Open this publication in new window or tab >>Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study
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2021 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 16, no 12, p. 3357-3368Article in journal (Refereed) Published
Abstract [en]

AIM: To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland.

DESIGN: Longitudinal register-based follow up study.

SETTING: Estonia, Latvia, Lithuania and Finland.

PARTICIPANTS: General population in the 35-74 age group.

MEASUREMENTS: Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality.

FINDINGS: Alcohol-related mortality increased in all countries in 2004-2007 except among Estonian women and decreased/remained the same from 2008 onwards except among Latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 vs. 2000-2003 in all countries except Estonia (decrease).

CONCLUSION: In Estonia, Latvia, Lithuania and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and tended to decrease more among the high educated during a period of economic recession (2008-2011).

Place, publisher, year, edition, pages
Wiley-Blackwell, 2021
Keywords
alcohol-related mortality, economic cycles, inequalities, register-based
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-45295 (URN)10.1111/add.15526 (DOI)000649168500001 ()33908662 (PubMedID)2-s2.0-85105498712 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1
Available from: 2021-05-03 Created: 2021-05-03 Last updated: 2022-07-12Bibliographically approved
Stickley, A., Baburin, A., Jasilionis, D., Krumins, J., Martikainen, P., Kondo, N. & Leinsalu, M. (2021). Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015: a register-based study. Scientific Reports, 11(1), Article ID 2397.
Open this publication in new window or tab >>Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015: a register-based study
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2021 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 2397Article in journal (Refereed) Published
Abstract [en]

This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 among 30-74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000-2003 and 2012-2015. From 2004-2007 to 2008-2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000-2003 to 2012-2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.

Place, publisher, year, edition, pages
Springer Nature, 2021
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-43892 (URN)10.1038/s41598-021-81135-5 (DOI)000668347900035 ()33504848 (PubMedID)2-s2.0-85099836548 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1Max Planck SocietyAcademy of Finland
Available from: 2021-02-01 Created: 2021-02-01 Last updated: 2022-09-15Bibliographically approved
Leinsalu, M., Baburin, A., Jasilionis, D., Krumins, J., Martikainen, P. & Stickley, A. (2020). Economic fluctuations and urban-rural differences in educational inequalities in mortality in the Baltic countries and Finland in 2000-2015: a register-based study. International Journal for Equity in Health, 19(1), Article ID 223.
Open this publication in new window or tab >>Economic fluctuations and urban-rural differences in educational inequalities in mortality in the Baltic countries and Finland in 2000-2015: a register-based study
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2020 (English)In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 19, no 1, article id 223Article in journal (Refereed) Published
Abstract [en]

We examined urban-rural differences in educational inequalities in mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in the context of macroeconomic changes. Educational inequalities among 30-74 year olds were examined in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 using census-linked longitudinal mortality data. We estimated age-standardized mortality rates and the relative and slope index of inequality. Overall mortality rates were larger in rural areas except among Finnish women. Relative educational inequalities in mortality were often larger in urban areas among men but in rural areas among women. Absolute inequalities were mostly larger in rural areas excepting Finnish men. Between 2000-2003 and 2012-2015 relative inequalities increased in most countries while absolute inequalities decreased except in Lithuania. In the Baltic countries the changes in both relative and absolute inequalities tended to be more favorable in urban areas; in Finland they were more favorable in rural areas. The overall pattern changed during the reccessionary period from 2004-2007 to 2008-2011 when relative inequalities often diminished or the increase slowed, while the decrease in absolute inequalities accelerated with larger improvements observed in urban areas. Despite substantial progress in reducing overall mortality rates in both urban and rural areas in all countries, low educated men and women in rural areas in the Baltic countries are becoming increasingly disadvantaged in terms of mortality reduction.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Educational inequalities, Macroeconomic changes, Mortality, Urban-rural differences
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-42986 (URN)10.1186/s12939-020-01347-5 (DOI)000600888600001 ()33334349 (PubMedID)2-s2.0-85097654846 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1
Available from: 2020-12-21 Created: 2020-12-21 Last updated: 2024-01-17Bibliographically approved
Leinsalu, M., Baburin, A., Jasilionis, D., Krumins, J., Martikainen, P. & Stickley, A. (2020). Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000–2015: A register-based study. Journal of Psychiatric Research, 131, 138-143
Open this publication in new window or tab >>Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000–2015: A register-based study
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2020 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 131, p. 138-143Article in journal (Refereed) Published
Abstract [en]

Introduction: In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. This study aimed to examine changes and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in relation to macroeconomic fluctuations. Methods: We analysed changes in overall suicide mortality and by educational level between the 2000–2003, 2004–2007, 2008–2011 and 2012–2015 periods among men aged 30–64 years using census-linked longitudinal mortality data. We estimated age-standardised mortality rates, mortality rate ratios (Poisson regression), the relative index of inequality and slope index of inequality. Results: Overall suicide mortality fell markedly from 2000–2003 to 2004–2007. The decline was largest among high educated men in the Baltic countries and among middle and low educated men in Finland. From 2004–2007 to 2008–2011, the positive trend slowed and while suicide mortality continued to fall among middle and low educated men, it increased somewhat among high educated men in all Baltic countries. In Finland, suicide mortality decreased among the high educated and increased slightly among low educated men. Conclusions: In the Baltic countries, lower educated men had a smaller decline in suicide mortality than higher educated men during a period of rapid economic expansion, however, they were not more disadvantaged during the recession, possibly because of being less exposed to financial loss. Consequently, relative inequalities in suicide mortality may increase during economic booms and decrease during recessions.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Economic cycles, Education, Inequalities, Recession, Suicide mortality, adult, all cause mortality, Article, Baltic States, economic development, economic recession, educational status, Finland, follow up, gross national product, human, longitudinal study, male, mortality rate, priority journal, suicide, unemployment, welfare
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-41995 (URN)10.1016/j.jpsychires.2020.09.009 (DOI)000591510400021 ()32971357 (PubMedID)2-s2.0-85091206133 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1
Available from: 2020-10-01 Created: 2020-10-01 Last updated: 2021-01-07Bibliographically approved
Leinsalu, M., Reile, R. & Stickley, A. (2019). Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-2016. Journal of Epidemiology and Community Health, 73(11), 1026-1032
Open this publication in new window or tab >>Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-2016
2019 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 11, p. 1026-1032Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the 2000s, the Baltic countries experienced unprecedented credit-driven economic growth that was followed by a deep recession. This study examined the impact of profound macroeconomic changes on population mental health in Estonia in 2004-2016.

METHODS: Data on 17 794 individuals in the 20-64 age group were obtained from seven nationally representative cross-sectional surveys. The prevalence of past 30-day depression was calculated for men and women further stratified by sociodemographic characteristics. Multivariable regression analysis was used to assess whether these characteristics were associated with the yearly variation in depression.

RESULTS: In 2006, the adjusted prevalence ratio for depression was 0.77 (95% CI 0.64 to 0.93) for men and 0.85 (95% CI 0.74 to 0.97) for women as compared with 2004; in 2010, the prevalence ratio as compared with 2008 for both men and women was 1.22 (95% CIs 1.04 to 1.43 and 1.09 to 1.37, respectively). Among men, the increase in the prevalence of depression in 2008-2010 was statistically significant for 35-64 year olds, ethnic Estonians, those who were married, mid-educated or were employed, whereas among women, a significant increase was observed in 50-64 year olds, Estonians and non-Estonians, those who were not-married, were highly educated or mid-educated, in the mid-income group or were employed.

CONCLUSIONS: Population mental health is responsive to macroeconomic changes. In less wealthy high-income countries, the greater impact of recession on depression among advantaged groups may relate to a higher debt burden coupled with job insecurity.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
depression, economic fluctuations, socioeconomic differences
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-38732 (URN)10.1136/jech-2018-211939 (DOI)000497280000008 ()31406016 (PubMedID)2-s2.0-85070606279 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2022-08-25Bibliographically approved
Co-InvestigatorLundberg, Olle
Principal InvestigatorLeinsalu, Mall
Co-InvestigatorStickley, Andrew
Coordinating organisation
Södertörn University
Funder
Period
2016-01-01 - 2018-12-31
Keywords [sv]
Östersjö- och Östeuropaforskning
Keywords [en]
Baltic and East European studies
National Category
Social Sciences InterdisciplinaryPublic Health, Global Health, Social Medicine and Epidemiology
Identifiers
DiVA, id: project:1930Project, id: P15-0520:1_RJ