Cervical cancer (CC) mortality in the Baltic countries remains high. We explored CC mortality trends and educational inequalities in CC mortality in the Baltics in the context of organized CC screening (introduced in 2004 in Lithuania, 2006 in Estonia and 2009 in Latvia) and compared the results with Finland (where screening started in 1963). Data for the Baltic countries came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. CC deaths (ICD-10 code C53) were linked from national mortality registries. Information on education was census- or register-based. Overall and education-specific age-standardized mortality rates (ASMRs) and mortality rate ratios were calculated for 2000–2007 and 2008–2015 for women aged 30–49 and 50–64 years. The Baltic countries had 5–9 times higher overall ASMRs than Finland and much larger inequalities in CC mortality between low- and highly educated women. From 2000–2007 to 2008–2015 absolute inequalities in younger women reduced in all countries, except Latvia and relative inequalities increased in Estonia and Latvia. In older women, absolute inequalities increased in the Baltics but not in Finland; relative inequalities increased in all countries. The reduction in CC mortality and in absolute inequalities in younger women in Estonia and Lithuania may be associated with the introduction of organized screening. However, increasing CC mortality among older low-educated women in the Baltic countries is alarming, indicating that they have not benefitted equally from CC prevention.

Background: Foreign-born residents in high-income countries often outlive the native-born population, but it remains unclear how this advantage varies across countries and socioeconomic groups. We aimed to assess socioeconomic inequalities in the life expectancy advantage of foreign-born populations across 10 European countries.

Methods: Using national population registers and census, we collected data on mortality by country of birth and educational attainment in 10 European countries from 2010 to 2019. Based on these data, we estimated partial life expectancy between ages 35 and 80 years for native-born and foreign-born populations in each country, both overall and by education. We then decomposed the overall gap between native- and foreign-born populations into differences in education-specific mortality and the educational composition of the population.

Results: Foreign-born populations had higher partial life expectancies than native-born populations in all countries except Sweden and Estonia, especially among individuals with low-level education. Decomposition analyses revealed that the overall longevity advantage of foreign-born populations was largely attributable to their lower mortality in less-educated groups. However, in most countries-except Estonia, Lithuania, and Spain-the overrepresentation of less-educated individuals among the foreign-born partially cancelled out these advantages.

Conclusions: The longevity advantages among foreign-born populations in European countries may reflect socioeconomic barriers that concentrate relatively healthy, resource-rich immigrants into lower socioeconomic groups. Improving how societies recognize and use the skills and resources of foreign-born populations can help reduce these barriers, benefiting their longevity outcomes and contributing to more inclusive societies.

OBJECTIVES: Smoking is one of the most important behavioural contributors to morbidity and mortality worldwide. However, the effects of smoking are not evenly distributed across society. We investigated trends in educational inequalities in smoking-attributable mortality in Europe and changes in its contribution to educational inequalities in partial life expectancy over time.

STUDY DESIGN: Post-census longitudinal mortality follow-up.

METHODS: Partial life expectancy between age 50-80 was calculated between 2000 and 2020 in ten European countries (Austria, Belgium, Denmark, Estonia, Finland, Italy (Turin), Lithuania, Spain (Barcelona), Sweden and Switzerland). We estimated the smoking-attributable fraction (SAF) using the Preston-Glei-Wilmoth method. Changes in partial life expectancy by education and educational inequalities in partial life expectancy were decomposed into the age-specific contributions attributable and not-attributable to smoking, using the continuous change model.

RESULTS: Among men, SAF decreased over time for all countries, but remained largest among those with lower education. For women SAF increased over time, but with a less profound educational gradient. For men, the contribution of smoking to educational differences in partial life expectancy ranged between 0·2 and 2·3 years and decreased between 2000 and 2020. Among women, it ranged between -0·1 and 0·9 years and increased or stabilized over time, except for Denmark.

CONCLUSION: Although smoking-attributable mortality decreased among men in all educational groups, smoking remains an important factor contributing to educational inequalities in life expectancy. For women the contribution of smoking to educational inequalities in life expectancy is increasing in most countries. The need for tobacco control measures to reduce these disparities remains high, especially for women.

Objectives To examine the association between food insecurity (FI) and loneliness in countries of the former Soviet Union (FSU).Methods Data were analysed from 15,568 adults in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine, collected in the Health in Times of Transition (HITT) survey in 2010-2011. Information was obtained on both FI and loneliness with single-item measures. Logistic regression was used to examine associations.Results In a fully adjusted analysis, moderate (OR: 1.35, 95% CI: 1.16-1.57) and severe FI (OR: 1.94, 95% CI: 1.58-2.38) were associated with significantly higher odds of loneliness in the pooled sample. In sex- and age-stratified analyses, severe FI was associated with loneliness in all population subgroups, with odds ratios ranging from 1.69 to 1.99. However, moderate FI was linked to loneliness in only three of the five subgroups. In further analyses, FI was associated with loneliness in six of the nine countries.Conclusion FI is associated with loneliness in FSU countries. Efforts to increase food security in these countries may be important for improving physical and psychological well-being among adults in the general population.

Smokers experience multiple disadvantages throughout their lives, yet there is another disadvantage, political, that is less widely recognised. Smokers are less likely to vote but only so far in studies conducted in Western democratic regimes. This cross-sectional study aimed to examine the association between current smoking and voting behaviour and intentions in nine countries of the former Soviet Union (FSU). Data were analysed from 18,000 individuals aged ≥ 18 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine, collected in the Health in Times of Transition (HITT) survey in 2010/11. Information was obtained on smoking status and voting behaviour and intentions. In a fully adjusted logistic regression analysis, current smoking was associated with significantly higher odds of 'never voting' (not having voted in the past or intending to vote in future) in the pooled sample (OR: 1.29, 95% CI 1.13-1.47). In stratified analyses, smoking was associated with never voting in women but not men and in young but not middle-aged or older adults. The smoking-never voting association was observed in flawed democracies (OR: 1.57, 95% CI 1.07-2.32) and hybrid regimes (OR: 1.31, 95% CI 1.08-1.59) but not in authoritarian regimes (OR: 1.02, 95% CI 0.81-1.29). Smoking is associated with never voting in these FSU countries although not in all population subgroups or types of political regime. A necessary task for future research will be determining the factors associated with not voting among smokers in these countries.

Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.

Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).

Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%).

Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

BACKGROUND: Despite an increased focus on cold-related mortality in recent years, there has been comparatively little research specifically on hypothermia mortality and its associated factors.

METHODS: Educational inequalities in hypothermia mortality among individuals aged 30-74 in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in 2000-15 were examined using data from longitudinal mortality follow-up studies of population censuses (the Baltics) and from a longitudinal register-based population data file (Finland).

RESULTS: Age-standardized mortality rates (ASMRs) were much higher in the Baltic countries than in Finland across the study period. From 2000-07 to 2008-15, overall ASMRs declined in all countries except among Finnish women. Although a strong educational gradient was observed in hypothermia mortality in all countries in 2000-07, inequalities were larger in the Baltic countries. Between 2000-07 and 2008-15, ASMRs declined in all educational groups except for high-educated women in Finland and low-educated women in Lithuania; the changes however were not always statistically significant. The absolute mortality decline was often larger among the low educated resulting in narrowing absolute inequalities (excepting Lithuania), whereas a larger relative decline among the high educated (excepting Finnish women) resulted in a considerable widening of relative inequalities in hypothermia mortality by 2008-15.

CONCLUSION: Although some reduction was observed in absolute educational inequalities in hypothermia mortality in 2000-15, substantial and widening relative inequalities highlight the need for further action in combatting factors behind deaths from excessive cold in socioeconomically disadvantaged groups, including risky alcohol consumption and homelessness.

Objectives

The Estonian National Mental Health Study (EMHS) was conducted in 2021–2022 to provide population-wide data on mental health in the context of COVID-19 pandemic. The main objective of this paper is to describe the rationale, design, and methods of the EMHS and to evaluate the survey response.

Methods

Regionally representative stratified random sample of 20,000 persons aged 15 years and older was drawn from the Estonian Population Register for the study. Persons aged 18 years and older at the time of the sampling were enrolled into three survey waves where they were invited to complete an online or postal questionnaire about mental well-being and disorders, and behavioral, cognitive, and other risk factors. Persons younger than 18 years of age were invited to fill an anonymous online questionnaire starting from wave 2. To complement and validate survey data, data on socio-demographic, health-related, and environmental variables were collected from six national administrative databases and registries. Additionally, a subsample was enrolled into a validation study using ecological momentary assessment.

Results

In total, 5636 adults participated in the survey wave 1, 3751 in wave 2, and 4744 in wave 3. Adjusted response rates were 30.6%, 21.1%, and 27.6%, respectively. Women and older age groups were more likely to respond. Throughout the three survey waves, a considerable share of adult respondents screened positive for depression (27.6%, 25.1%, and 25.6% in waves 1, 2, and 3, respectively). Women and young adults aged 18 to 29 years had the highest prevalence of depression symptoms.

Conclusions

The registry-linked longitudinal EMHS dataset comprises a rich and trustworthy data source to allow in-depth analysis of mental health outcomes and their correlates among the Estonian population. The study serves as an evidence base for planning mental health policies and prevention measures for possible future crises.

Poorer mental health is linked to a lower likelihood of voting in elections. However, little is known about this association in non-Western settings. This study examined the association between psychological distress and voting in nine countries of the former Soviet Union (FSU). Data were analysed from 18,000 respondents aged ≥ 18 in Armenia, Azerbaijan, Belarus, Georgia, Moldova, Kazakhstan, Kyrgyzstan, Russia and Ukraine collected during the Health in Times of Transition (HITT) survey in 2010/11. Information was collected on previous voting behaviour and future voting intentions. Psychological distress was assessed with a 12-item scale. In pooled multivariable logistic regression analyses psychological distress was significantly associated with ‘never voting’ (not having voted previously or intending to vote in future) and ‘past voting only’ (having voted previously but not intending to vote in future). In stratified analyses psychological distress was linked to never voting in women and working-age adults. The significant association between psychological distress and voting was observed only in hybrid political regimes. Psychological distress is associated with a reduced likelihood of voting in FSU countries especially among women, working-age adults and those in hybrid political regimes.