| 1. |
- Eikemo, Terje A., et al.
(författare)
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How Can Inequalities in Mortality Be Reduced? : A Quantitative Analysis of 6 Risk Factors in 21 European Populations
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:11, s. e110952-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.
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| 2. |
- Enroth, Linda, et al.
(författare)
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Changes in socioeconomic differentials in old age life expectancy in four Nordic countries : the impact of educational expansion and education-specific mortality
- 2022
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Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 19:2, s. 161-173
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Tidskriftsartikel (refereegranskat)abstract
- Overall progress in life expectancy (LE) depends increasingly on survival in older ages. The birth cohorts now reaching old age have experienced considerable educational expansion, which is a driving force for the social change and social inequality. Thus, this study examines changes in old age LE by educational attainment in the Nordic countries and aims to fnd out to what extent the change in national LEs is attributable to education-specifc mortality and the shifting educational composition. We used national register data comprising total 65+populations in Denmark, Finland, Norway and Sweden to create period life tables stratifed by fve-year age groups (65–90+), sex and educational attainment. Difference in LE between 2001 and 2015 was decomposed into the contributions of mortality changes within each educational group and changes in educational composition. Increasing LE at all ages and in all educational groups coincided with persistent and growing educational inequalities in all countries. Most of the gains in LE at age 65 could be attributed to decreased mortality (63–90%), especially among those with low education, the largest educational group in most countries. The proportion of the increase in LE attributable to improved education was 10–37%, with the highest contributions recorded for women in Norway and Sweden. The rising educational levels in the Nordic countries still carry potential for further gains in national LEs. However, the educational expansion has contributed to uneven gains in LE between education groups, which poses a risk for the future increase of inequalities in LE.
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| 3. |
- Jasilionis, Domantas, et al.
(författare)
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Changing effect of the numerator-denominator bias in unlinked data on mortality differentials by education : evidence from Estonia, 2000-2015
- 2021
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 75:1, s. 88-91
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Jasilionis, Domantas, et al.
(författare)
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L’avant-garde en matière d’espérance de vie montre-t-elle la voie au reste de la population?
- 2014
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Ingår i: Population. - : CAIRN. - 0032-4663 .- 1957-7966. ; 69:4, s. 589-615
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Tidskriftsartikel (refereegranskat)abstract
- Do vanguard populations open new frontiers of survival and longevity that will eventually be reached by others? The main aim of this study is to identify the extent to which the non-vanguard populations in Finland, Norway, and Sweden might follow the mortality trajectories of the vanguard groups in these countries for different age ranges and for the major causes of death. The results show no systematic convergence between vanguard and non-vanguard sub-populations. On the contrary, they confirm the theory whereby each major epidemiological development initially gives rise to divergence in mortality trends. Our study found that at the sub-national level, rather than simply following (with a certain time lag) the same path as the vanguard groups, non-vanguard groups have their own pathways to low mortality which are related to specific determinants of mortality change. The study also found that a long time is needed for the non-vanguard group to attain the mortality levels already reached by the vanguard group at the start of the observation period. This is notably the case for the treatment and prevention of cardiovascular diseases.
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| 5. |
- Junna, Liina M., et al.
(författare)
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Exploring the longevity advantage of doctorates in Finland and Sweden : The role of smoking- and alcohol-related causes of death
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:4, s. 419-422
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Tobacco smoking and alcohol use contribute to differences in life expectancy between individuals with primary, secondary and tertiary education. Less is known about the contribution of these risk factors to differences at higher levels of education. We estimate the contribution of smoking and alcohol use to the life-expectancy differences between the doctorates and the other tertiary-educated groups in Finland and in Sweden. Methods: We used total population data from Finland and Sweden from 2011 to 2015 to calculate period life expectancies at 40 years of age. We present the results by sex and educational attainment, the latter categorised as doctorate or licentiate degrees, or other tertiary. We also present an age and cause of death decomposition to assess the contribution of deaths related to smoking and alcohol. Results: In Finland, deaths related to smoking and alcohol constituted 48.6% of the 2.1-year difference in life expectancy between men with doctorate degrees and the other tertiary-educated men, and 22.9% of the 2.1-year difference between women, respectively. In Sweden, these causes account for 22.2% of the 1.9-year difference among men, and 55.7% of the 1.6-year difference among women, which in the latter case is mainly due to smoking. Conclusions: Individuals with doctorates tend to live longer than other tertiary-educated individuals. This difference can be partly attributed to alcohol consumption and smoking.
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| 6. |
- Meinow, Bettina, et al.
(författare)
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Trends over two decades in life expectancy with complex health problems among older Swedes : implications for the provision of integrated health care and social care
- 2022
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Ingår i: BMC Public Health. - London, United Kingdom : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years.Methods: CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged >= 77 years with waves in 1992, 2002 and 2011 (n approximate to 2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP.Results: Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%).Conclusions: The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
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| 7. |
- Mäki, Netta, et al.
(författare)
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Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries
- 2013
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 94, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Healthy life expectancy is a composite measure of length and quality of life and an important indicator of health in aging populations. There are few cross-country comparisons of socioeconomic differences in healthy life expectancy. Most of the existing comparisons focus on Western Europe and the United States, often relying on older data. To address these deficiencies, we estimated educational differences in disability-free life expectancy for eight countries from all parts of Europe in the early 2000s. Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a recent project comparing health inequalities between European countries (the EURO-GBD-SE project). We calculated sex-specific educational differences in disability-free life expectancy between the ages of 30 and 79 years using the Sullivan method. The lowest disability-free life expectancy was found among Lithuanian men and women (33.1 and 39.1 years, respectively) and the highest among Italian men and women (42.8 and 44.4 years, respectively). Life expectancy and disability-free life expectancy were directly related to the level of education, but the educational differences were much greater in the latter in all countries. The difference in the disability-free life expectancy between those with a primary or lower secondary education and those with a tertiary education was over 10 years for males in Lithuania and approximately 7 years for males in Austria, Finland and France, as well as for females in Lithuania. The difference was smallest in Italy (4 and 2 years among men and women, respectively). Highly educated Europeans can expect to live longer and spend more years in better health than those with lower education. The size of the educational difference in disability-free life expectancy varies significantly between countries. The smallest and largest differences appear to be in Southern Europe and in Eastern and Northern Europe, respectively.
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| 8. |
- Rehm, Jürgen, et al.
(författare)
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Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact
- 2023
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 118:3, s. 449-458
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020.Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed.Results: All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans.Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).
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| 9. |
- Rehm, Jürgen, et al.
(författare)
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Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020
- 2023
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Ingår i: The Lancet Regional Health. - 2666-7762. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time -series analyses suggest improved health, measured as reductions in all -cause and alcohol -attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol -attributable deaths. The natural experiment in this region of high -income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.
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| 10. |
- Shkolnikov, Vladimir M., et al.
(författare)
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Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 1971-2000
- 2012
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 66:4, s. 372-378
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives Studies on socioeconomic health disparities often suffer from a lack of uniform data and methodology. Using high quality, census-linked data and sensible inequality measures, this study documents the changes in absolute and relative mortality differences by education in Finland, Norway and Sweden over the period 1971 to 2000.Methods The age-standardised mortality rates and the population exposures for three educational categories were computed from detailed data provided by the national statistical offices. Mortality disparities by education were assessed using two range measures (rate differences and rate ratios), and two Gini-like measures (the average inter-group difference (AID) and the Gini coefficient (G)). The formulae for the decomposition of the change in the AID into (1) the contribution of change in population composition by education, and (2) the contribution of mortality change were introduced.Results Mortality decreases were often greater for high than for medium and low education. Both relative and absolute mortality disparities tend to increase over time. The magnitude and timing of the increases in absolute disparities vary by country. Both the rate differences and the AIDs have increased since the 1970s in Norway and Sweden, and since the 1980s in Finland. The contributions of the changes in population composition to the total AID increase were substantial in all countries, and for both sexes. The mortality contributions were substantial for males in Norway and Sweden.Conclusions The study reports increases in absolute mortality disparity, and its components. This trend needs to be further studied and addressed by policies.
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