Väestötiede ja kvantitatiivinen sosiaalitutkimus

Pekka MartikainenPekka.Martikainen@helsinki.fi

http://blogs.helsinki.fi/pmartika/

Laitoksella tehtävästä kvantitatiivisesta tutkimuksesta

Kvantitatiivista tutkimusta tehdään laitoksessa useassa tutkimusryhmässä

Kuolleisuus- ja terveystutkimusIkääntyvän väestön tutkimusKaupunkitutkimus (aluetutkimus)Kvantitatiivinen perhetutkimus (Jalovaara)Namibia/Afrikka-tutkimus (Shemeikka)

JOITAIN TUTKIMUSTEEMOJA

Kuolleisuus ja terveys sosioekonomiset erot ja niiden muutos koulutus ja tulot siviilisääty ja perherakenne elämäntapahtumat kansainväliset vertailut (hyvinvointivaltio-keskustelu) alkoholilainsäädännön vaikutukset

Alue-vaikutukset sosioekonominen rakenne, yhteisöllisyys ja koheesio kuolleisuus, terveys, itsemurha alueellinen eriytyminen muuttoliike pienalueet ja maakunnat/seutukunnat

Vanheneva väestö asuinolot ja köyhyys perherakenne, yksin eläminen, avoliitto epävirallinen hoiva ja sukulaissuhteet elämätapahtumat ja niiden seuraukset

sairastuminenleskeytyminen

laitostuminen perhevaikutukset terveydessä

Types of data sources

Individual level data on the Finnish population 1970+ Based on

Censuses from 1970-2005 (every 5-years)Population registration 1987-2006 (annual)

Linked with data on e.g.Mortality, hospital discharge and medicationTaxationEstablishment recordsContextual information (eg. area)

Linkage is based on social security numbers Allows:

Longitudinal analysesIdentify couples/households

… continued

10% sample of the 1950 census Based on

1950 Census (household based)Population census and registration from 1970

onwardsExpanding family study

… continued

Surveys data on the employees of the City of Helsinki Based on questionnaires to employees in 2000 Re-surveyed in 2007/8 Linked with data from various registers (STAKES, KELA, City of

Helsinki) Health 2000 Survey

Nationally representative survey of Finns in 2000 Also medically examined

Päijät-Häme (Ikihyvä) survey in the Area of Lahti Also medically examined and re-surveyed

All data sets contain information on: Various health issues However, also rich in various social, behavioral and attitudinal

questions

Vanhusten asumismuotojen muutos, laitoshoito ja epävirallinen hoiva

Population projection 2003-2040 by age

0200000400000600000800000

100000012000001400000160000018000002000000

2003 2013 2023 2033 2043

Year

Num

ber 20-60

65+

80+

Sources of care

Formal care ~ care from the public sector / paid care from the private sector

care in the communityinstitutional care

Informal care ~ ’help from family, friends and relatives’

Men Women

Spouse 57 34

Children 33 42

Other relatives/friends 37 31

Formal support 8 11

Main sources of support and help among 75 year old men and women in Finland (%) living in the community

% does not add up 100 as support can be obtained simultaneously from several sources

Living arrangements by sex in Finland in 1970-2000 75 years and over

MEN

0

10

20

30

40

50

60

70

80

90

100

1970 1975 1980 1985 1990 1995 2000

(%)

Alone SpouseSpouse and children ChildrenWith others Other

WOMEN

0

10

20

30

40

50

60

70

80

90

100

1970 1975 1980 1985 1990 1995 2000

(%)

Alone SpouseSpouse and children ChildrenWith others Other

Tavallisiin toimiin saatu apu avunantajatahon mukaan puolison kanssa asuvilla, ikävakioidut prosenttiosuudet, 70 vuotta täyttäneet

Puolison kanssa asuvat naiset (N=207)

17

6

20

3

22

6

9

11

5

11

1

8

3

2

10

4

10

5

10

15

20

25

30

35

40

Puo

lisol

ta

Laps

ilta

tai

heid

änpu

olis

oilta

anM

uilta

suku

lais

ilta,

ystä

viltä

jne.

E

pävi

ralli

silta

taho

ilta

yhte

ensä

Vira

llisi

ltata

hoilt

ayh

teen

sä

Kai

kki a

puyh

teen

sä

Harvemmin kuin kerran viikossa Yhden - muutaman kerran viikossaVähintään päivittäin

Puolison kanssa asuvat miehet (N=286)

16

2

17

2

18

2

72

5

2

4

7

2

2

6

3

0

5

10

15

20

25

30

35

40

Puo

lisol

ta

Laps

ilta

tai

heid

änpu

olis

oilta

anM

uilta

suku

lais

ilta,

naap

urei

lta,

Epä

vira

llisi

ltata

hoilt

ayh

teen

säV

iralli

silta

taho

ilta

yhte

ensä

Kai

kki a

puyh

teen

sä

Tavallisiin toimiin saatu apu avunantajatahon mukaan yksin asuvilla, ikävakioidut prosenttiosuudet, 70 vuotta täyttäneet

Yksin asuvat naiset (N=483)

41

5 59

13

6

15

8

17

9

8

11

9

13

00

5

10

15

20

25

30

35

40

Puo

lisol

ta

Laps

ilta

tai

heid

änpu

olis

oilta

anM

uilta

suku

lais

ilta,

ystä

viltä

jne.

E

pävi

ralli

silta

taho

ilta

yhte

ensä

Vira

llisi

ltata

hoilt

ayh

teen

sä

Kai

kki a

puyh

teen

sä

Yksin asuvat miehet (N=107)

3 2 47

1110

5

14 10

18

16

413

9

00

5

10

15

20

25

30

35

40

Puo

lisol

ta

Laps

ilta

tai

heid

änpu

olis

oilta

anM

uilta

suku

lais

ilta,

ystä

viltä

jne.

Epä

vira

llisi

ltata

hoilt

ayh

teen

säVira

llisi

ltata

hoilt

ayh

teen

sä

Kai

kki a

puyh

teen

sä

Determinants of entry into long-term care

Known to be associated for example with: poor health and functioning (e.g. dementia) living arrangements (e.g. living alone) living conditions (e.g. inadequate housing) low socioeconomic position (e.g. low income)

Strength of these effects and their relative contribution not well established

How is institutional care distributed over the life-course Life-events: widowhood Most results cross-sectional ‘Pathways’ not well established

Low SES -> poor housing -> poor health -> Institution

An example of dataAn example of data content for a content for a study of entry into institutional carestudy of entry into institutional care

Sociodemographic Sociodemographic factors:factors:Sex, sexSex, sexMarital statusMarital statusLiving Living arrangements arrangements EducationEducationSocial classSocial classIncomeIncomeHousingHousingPartnerPartnerRegionRegionDate/cause of Date/cause of death death

Use of homecare Use of homecare servicesservices

Institutional care:Institutional care: Care episodesCare episodes Date of entryDate of entry Date of exitDate of exit Type of Type of

institutioninstitution Supply of care:Supply of care:Regional coverage Regional coverage

of institutional of institutional carecare

STAKESStatisticsFinland

STAKES

STAKES

STAKES

Pension instituteHealth:Health:

MedicationMedication

Hospital Hospital dischargedischarge

Distribution by gender and living arrangements. Finnish older adults aged 65 and over living in the community

72

36

22

50

6 14

0%

20%

40%

60%

80%

100%

Men (N=108 474) Women (N=172 248)

with othersalonewith spouse

Probability of survival without long-term institutionalisation by living arrangements among Finnish older adults living in the community at baseline

0

500

1000

1500

2000

0.75

0.80

0.85

0.90

0.95

1.00

Time in months

Kap

lan-

Mei

er s

urvi

val e

stim

ate

0 12 24 36 48 60 69

0.75

0.80

0.85

0.90

0.95

1.00 WOMEN

0.914

0.842

0.801

0.797

with spouse

total

with others

alone

Figure 1. Relative age-adjusted institutionalization rates in relation to duration of bereavement, Finnish elderly 65+ (Reference = married)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0-1 1-2 2-3 3-6 6-12 12-24 24-36 36-42 42+

Time since spouse's or partner's death (months)

Haz

ard

ratio

(ins

titut

iona

lizat

ion)

MEN

WOMEN

Nihtilä and Martikainen, 2006

Hazard ratios (women vs. men) of institutionalisation and mode of exit from institution

Total (N=280722) Those institionalised (N=35926)First entry Died in institution Returned home Total exit

Model Hazard ratio Hazard ratio Hazard ratio Hazard ratio

unadjusted 1.42 0.70 0.81 0.74age-adjusted 1.12 0.66 0.89 0.75age+living arrangement 0.97 0.68 0.92 0.77age+household income 1.10 0.67 0.90 0.75age+home ownership 1.09 0.66 0.90 0.75age+health status 1.08 0.67 0.88 0.75full model 0.94 0.68 0.91 0.77

Martikainen, Moustgaard, Murphy, Nihtilä, Koskinen, Martelin, Noro, The Gerontologist 2008

= >

Adjusted for age:

Women stay in care on average 1064 days- if living with spouse at baseline 994 days- if living alone at baseline 1105 days

Men stay in care on average 686 days- if living with spouse at baseline 645 days- if living alone at baseline 746 days

Kuolleisuus- ja terveyserot

Fig. 1. Life expectancy at age 35 in the period 1983–2005 by social class, men and women.

(3 years moving averages).

34

36

38

40

42

44

46

48

50

52

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Year

Years

WOMENUpper white-collarLower white-collar

WorkersFarmers

MENUpper white-collar

Lower white-collar

Farmers

Workers

Fig. 2. Decomposition of the change in life expectancy at age 35 between periods 1998-2000 and 2003-2005 by cause of death and social

class, men.

-0,2 0,0 0,2 0,4 0,6 0,8

Lung cancer

Other cancers

Ischaemic heart diseases

Cerebrovascular diseases

Other cardiovascular diseases

Respiratory diseases

Alcohol associated causes 1)

Other diseases

Suicide

Accidents and violence 2)

Change in life expectancy, years

Upper white-collar

Lower white-collar

Workers

1) Alcohol associated diseases and accidental poisoning by alcohol2) Excluding poisoning by alcohol

Total change in life expectancy (years):Upper w hite-collar 1,2Low er w hite-collar 1,45Workers 1,27

Fig. 3. Decomposition of the change in life expectancy at age 35 between periods 1998-2000 and 2003-2005 by cause of death and social

class, women.

-0,2 0,0 0,2 0,4 0,6 0,8

Lung cancer

Breast cancer

Other cancers

Ischaemic heart diseases

Cerebrovascular diseases

Other cardiovascular diseases

Respiratory diseases

Alcohol associated causes 1)

Other diseases

Suicide

Accidents and violence 2)

Change in life expectancy, years

Upper white-collar

Lower white-collar

Workers

Total change in life expectancy (years):Upper w hite-collar 1,17Low er w hite-collar 0,86Workers 1,00

1) Alcohol associated diseases and accidental poisoning by alcohol2) Excluding poisoning by alcohol

Fig. 4. Difference in life expectancy between upper white-collar employees and workers in the period 1983-2005 and target set by the

Health 2015 - Public Health Program.

5,0

5,6 5,76,1

2,32,7 3,0 3,2

6,1

3,3

4,4

2,4

0

1

2

3

4

5

6

7

1984 1989 1994 1999 2004 2009 2014Year

Years

MenWomenMen - targetWomen - target

Poverty has been suggested as an important cause of socioeconomic inequalities in mortality and morbidity

This possibility is interesting from the scientific point of view, but also from the point of view income redistribution policies

Relatively little empirical data on the effects of income on health is available at present

0 10 20 30 40 50 60 U S $

0

0 .5

1

1 .5

2

2 .5

3 R R

U S A

45 -64

65 +

10 30 50 70 90 11 0 13 0 F IM

0

0.5

1

1 .5

2

2 .5

3 R R

F IN L A N D

30 -64

65 +

Age-adjusted relative mortality rates by income among men

Source: USA: Backlund, Sorlie, Johnson; Ann Epidemiol 6:1, 1996 Finland: Martikainen, Mäkelä, Koskinen, Valkonen; IJE 30, 2001

Household equivalent income and self-assessed health (SAH) among men in Finland, Neatherlands and England & Wales

0 10 20 30 40 50 60 70

1.2

1.4

1.6

1.8

2

2.2

2.4

2.6

2.8 SAH

FI

0 10 20 30 40 50 60 70

1.2

1.4

1.6

1.8

2

2.2

2.4

2.6

2.8

NL

0 10 20 30 40 50 60 70

1.2

1.4

1.6

1.8

2

2.2

2.4

2.6

2.8

EN

Income

SELECTION, CONFOUNDING OR CAUSATION?

Problems of interpreting the association between income and health may be a partial cause of the relative scarcity of research

'... the basic presupposition in studies of socioeconomic differentials in mortality is that socioeconomic status has an effect on mortality. In the case of income differentials, however, this causal pathway is complicated by a reverse path in which the approach of death itself is the cause of decreased income during the years preceding death.' (Kitagawa and Hauser, 1973)

FOUR APPROAHES:

Preference for household based measures of income and post-tax income (rarely available)

Adjustment for possible confounders

Analyses of longitudinal data

Analyses of the shape of the relationship between income and healthcurvi-linear linear

Age adjusted and fully adjusted hazard ratios of mortality by different measures of income. Women aged 30-64

0.0

1.0

2.0

3.0

4.0

0 10000 20000 30000 40000 50000

Individual taxable income

HR

0.0

1.0

2.0

3.0

4.0

0 10000 20000 30000 40000 50000Household taxable income

HR

0.0

1.0

2.0

3.0

4.0

0 10000 20000 30000 40000 50000Household consumption income

HR

---- Adjusted for age---- Adjusted for age, educational attainment, occupational social class and economic activity

Age adjusted and fully adjusted hazard ratios of mortality by different measures of income. Women aged 65+

---- Adjusted for age---- Adjusted for age, educational attainment, occupational social class and economic activity

0.8

1.0

1.2

1.4

1.6

0 10000 20000 30000 40000 50000Individual taxable income

HR

0.8

1.0

1.2

1.4

1.6

0 10000 20000 30000 40000 50000Household taxable income

HR

0.8

1.0

1.2

1.4

1.6

0 10000 20000 30000 40000 50000Household consumption income

HR

Hazard ratios of mortality in 1998-2004 by individual taxable income in 1997. Men 30-42 years

Men HR HR HR HR HR1. Decile (highest) 1,00 1,00 1,00 1,00 1,002. Decile 1,20 1,17 1,07 1,01 1,043. Decile 1,53 1,46 1,30 1,18 1,214. Decile 1,57 1,50 1,31 1,17 1,195. Decile 2,04 1,95 1,69 1,52 1,436. Decile 2,74 2,62 2,27 2,10 1,547. Decile 3,93 3,74 3,16 2,92 1,768. Decile 4,75 4,53 3,78 3,45 1,909. Decile 6,73 6,34 5,16 4,74 2,4210. Decile 7,74 7,35 5,84 5,42 2,88

+ education + social class + income 1987

+ education + social class

1997

+ economic activity 1997

Age + income

1997

+ parental social characteristics

1970

Hazard ratios of mortality in 1998-2004 by individual taxable income in 1997. Women 30-42 years

Women HR HR HR HR HR1. Decile (highest) 1,00 1,00 1,00 1,00 1,002. Decile 0,71 0,70 0,73 0,71 0,723. Decile 0,83 0,83 0,88 0,83 0,864. Decile 0,81 0,80 0,86 0,78 0,815. Decile 0,82 0,80 0,84 0,75 0,786. Decile 1,15 1,12 1,15 1,03 0,957. Decile 1,84 1,79 1,78 1,60 1,168. Decile 1,95 1,89 1,80 1,61 1,019. Decile 2,51 2,43 2,30 2,04 1,3310. Decile 3,11 3,02 2,48 2,23 1,60

+ education + social class + income 1987

+ education + social class

1997

+ economic activity 1997

Age + income

1997

+ parental social characteristics

1970

Life-expectancy at age 35 by household income

0

10

20

30

40

50

60

1988 1990 1992 1994 1996 1998 2000 2002 2004

Life

-exp

ecta

ncy

naiset köyhin 20 %

naiset rikkain 20 %

naiset keski 60 %

miehet köyhin 20 %

miehet rikkain 20 %

miehet keski 60 %

Women poorest 20%

Women richest 60%

Men poorest 20%

Men mid 60%

Men richest 20%

Women mid 60%

Työttömyys ja kuolleisuus

Why are the effects of unemployment on health interesting?

The effects of unemployment are of particular interest in recessionary times

=> public health and equity => policy

These effects are of interest also from a more general research point of view on the etiology of disease

=> unemployment as a stressful life-event

Previous evidence clearly indicates that unemployment is strongly associated with ill-health and mortality

Why is unemployment related to mortality?

Causal effects of unemployment: Becoming jobless and prolonged redundancy have negative effects on health and increase the risk of premature death.

Increased psychosocial stressTobacco and alcohol consumptionLoss of income and material deprivation

Selection: Persons likely to become unemployed, or to have difficulty in re-employment, have pre-existing ill-health and/or "lifestyle" (e.g. tobacco and alcohol consumption, diet), socioeconomic (e.g. social class, housing tenure) or personal characteristics (e.g. age, sex, physical weakness, psychological characteristics, and early life experiences) that increase the risk of future ill-health and mortality.

Figure 1. Possible pathways between unemployment, job insecurity and health

Martikainen and Ferrie: Encyclopedia of Public Health, 2008

Martikainen; BMJ, 1990

Natural experiments

• ‘Occasionally, under naturally occurring conditions part of the study population is randomly exposed to a an agent or an event. A comparison of the naturally exposed group to a not exposed reference group closely resembles a controlled experiment. Inferences about causality are strong under such conditions’

• ‘Factory closure’ -studies• Most are under-powered (Morris et al.)

• Can be deduced from Finnish register data– 1990 recession; unemployment rose from about 4% to 20% in

three years – Direct observation of workplace downsizing

Figure 2. Mortality by cause and self-inflicted injury leading to hospital admission in 1986-94 following plant closure in New

Zealand meat processing workers.

0

1

2

3

4

5

6

7

8

9

All deaths Cancer Heart diseases Cerebrovasculardiseases

Respitatorydiseases

Suicide Other externalinjuries

Self-infectedinjury

Rel

ativ

e ri

sk a

djus

ted

for

age,

sex

and

ethn

icity

Keefe et al. IJE, 2002

Unemployment rate by sex

Source: Martikainen&Valkonen 1995

Women

Men

Age-adjusted mortality (deaths/100.000)) for selected accidental and violent causes of death 1980-93, 15-64-year-old men and women

(two year moving averages)

Source: Martikainen&Valkonen 1995

SuicideSuicide

Other accidents

Other accidents

Motor vehicle accidents

Poisonings

Poisonings

Men Women

Motor vehicle accidents

Martikainen, Mäki and Jäntti

TO SUMMARIZE

The effects of unemployment on mental well-being are well established in longitudinal studies

The effects of unemployment on mortality and physical health are more difficult to demonstrate and quantify, because the effects of selection are difficult to eliminate.

The effects are typically much smaller in natural experimental designs than in ’traditional’ follow-up studies => the causal effects of unemployment may be easily overestimated

Policy: The effects of mass unemployment and recession on public health are difficult to extrapolate from findings obtained in good economic times.

Alkoholin hinnanmuutosten vaikutukset kuolleisuuteen

Acute alcohol-related deaths per 100,000 by age, men

0

50

100

150

200

250

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Chronic alcohol-related deaths per 100,000 by age, men

0

50

100

150

200

250

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Acute alcohol-rel deaths per 100,000 by age, women

0

10

20

30

40

50

60

70

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Chronic alcohol-rel deaths per 100,000 by age, women

0

10

20

30

40

50

60

70

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Herttua K, Mäkelä P, Martikainen P. American Journal of Epidemiology 2008

Annual number of alcohol-related deaths due to major causes before (=blue) and after (= red) the price reduction

0

200

400

600

800

1000

liver pd ot d dis circ dis suic

Deaths

0

200

400

600

800

1000

land tr falls drow n ot acc assault

Deaths

39

13

2514

1

12

23

-13

0

20

Herttua K, Mäkelä P, Martikainen P. American Journal of Epidemiology 2008

2001-2003 Change

CI CI

Age 0.012ª 30-39 22.8 217 60.9 1.00 13.5 (0.8-27.8) 8.2 40-49 24.9 630 161.3 2.65 (2.42-2.90) 6.3 (0.0-14.1) 10.2 50-59 24.4 951 248.5 4.08 (3.75-4.44) 23.9 (17.4-30.8) 59.4 60-69 15.0 621 264.4 4.34 (3.97-4.75) 15.4 (7.8-23.5) 40.7 70-79 9.7 290 190.2 3.12 (2.82-3.46) 6.0 (-4.3-17.4 11.4 80+ 3.3 40 78.6 1.29 (1.07-1.57) 16.9 (-9.9-51.7) 13.3Education 0.625ª High 7.9 76 61.4 1.00 7.8 (-11.3-31.1) 4.8 Lower high 18.2 270 94.5 1.48 (1.28-1.71) 16.0 (4.7-28.5) 15.1 Intermediate 35.8 921 164.2 2.71 (2.37-3.10) 20.3 (13.9-27.0) 33.3 Basic 38.2 1483 247.7 3.52 (3.08-4.03) 16.1 (11.0-21.5) 39.9Social class 0.777ª Upper non-manual 16.5 212 82.0 1.00 8.4 (-3.7-22.0) 6.9 Lower non-manual 18.4 360 124.7 1.54 (1.40-1.70) 14.2 (4.4-24.9) 17.7 Skilled worker 25.5 854 213.5 2.56 (2.35-2.79) 17.0 (10.4-24.0) 36.3 Unskilled worker 19.7 879 285.1 3.43 (3.14-3.74) 18.2 (11.6-25.1) 51.9 Self-employed 9.1 200 139.9 1.57 (1.40-1.76) 14.9 (1.8-29.6) 20.8 Other 10.8 245 144.0 1.79 (1.61-1.99) 11.1 (-0.5-23.9) 16.0

¹ Unstandardized.² Age-adjusted.³ Derived from age-adjusted interaction term between indicator and period.4 Obtained from percentage calculation of the first period.ª p-value for difference in change obtained from a model that includes interaction term between indicator an period.

Table 1 Crude and age-adjusted alcohol-related mortality rates before (2001-2003) and after (2004-2005) the reduction in the price of alcohol by socioeconomic indicators, Finnish men aged 30+ years

Years at risk %

Deaths /year N

Per 100,000¹ RR² %³

Per 100,0004

Herttua K, Mäkelä P, Martikainen P. American Journal of Epidemiology 2008

Change2001-2003 Model 1 Model 2

CI CI CI

Main activity 0.001ª Employed 78.4 530 59.9 1.00 2.9 (-4.7-11.1) 1.7 Unemployed 25 mo+ 5.4 477 783.7 12.11 (11.28-13.01) 21.2 (11.7-31.5) 166.1 Unemployed, other 4.0 153 336.9 5.54 (4.99-6.15) 30.1 (14.2-48.1) 101.4 Pensioned 6.9 482 619.1 8.15 (7.58-8.76) 27.1 (18.0-36.9) 167.8 Other 5.3 156 259.5 4.50 (4.06-4.99) 21.5 (6.3-38.8) 55.8Income <0.001ª <0.001ª 1 (highest) 28.7 222 68.6 1.00 17.2 (5.6-30.1) 11.8 13.5 (2.3-26.0) 9.3 2 22.8 250 96.7 1.56 (1.40-1.73) 17.5 (5.3-31.0) 16.9 2.5 (-8.1-14.4) 2.4 3 18.1 257 125.9 2.19 (1.97-2.43) 78.8 (61.7-97.7) 99.2 44.8 (30.9-60.1) 56.4 4 14.1 380 238.0 4.18 (3.80-4.60) 64.0 (50.6-78.6) 152.3 37.4 (26.6-49.6) 89.0 5 (lowest) 14.2 586 365.7 6.26 (5.72-6.84) 19.4 (10.4-29.2) 70.9 22.1 (12.8-32.1) 80.8

¹ Unstandardized.² Age-adjusted (for main activity and income in Model 1)³ Derived from age-adjusted interaction term between each variable and period.4 Obtained by multiplying the mortality rate before the change by the percentage change.ª p-value for difference in change obtained from a model that includes interaction term between each variable and period.Model 1: adjusted for ageModel 2: adjusted for age and main activity

Table 3 Alcohol-related mortality before (2001-2003) and after (2004-2005) the reduction in the price of alcohol by main activity and household income per consumption unit, Finnish men aged 30-59 years

Years at risk %

Deaths /year N

Deaths /100,000¹ RR² %³

Deaths /100,0004 %³

Deaths /100,0004

Herttua K, Mäkelä P, Martikainen P. American Journal of Epidemiology 2008

GraduaiheitaJoitain menossa olevia graduja

Oldest-old kuolleisuus Avioeron vaikutukset terveyteen ‘Koulupudokkaiden’ elämänurat (työurat) Sosiaalinen liikkuvuus

Väitöskirjahankkeita Itsemurhakuolleisuuden sosiaaliset tekijät Alkoholin hinnanmuutoksen vaikutukset haittoihin Lasten kuolleisuuden sosiaaliset määrittäjät Vanhusten laitoshoito Suomenruotsalaisten kuolleisuus Rikollisuuden sosiaaliset syyt ’Consequences of mental illness’

Graduaiheita

Aihepiirejä ja teemoja Karjalan siirtolaisten elämänurat Elinkaari vaikutukset Köyhyyden, koulutuksen, omistamisen, terveyden, etc ‘periytyminen’ ja

kasautuminen asuntokuntiin. Puolisovaikutukset Vanhusten kotitalousrakenteen muutos Huonon terveyden vaikutukset ‘consequences of ill-health’ Työpaikan supistamisen vaikutukset ja työmarkkinat Eläkkeelle ja varhaiseläkkeelle siirtyminen ja sen vaikutukset Laitoshoitoa määrittävät tekijät Vertailevat tutkimukset

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