Changes in Chlamydia trachomatis risk before and after union formation and separation among women of reproductive age.

BACKGROUND: Not having an established relationship is associated with an elevated risk of Chlamydia trachomatis (CT) infection, but this might reflect selection into and out of unions. Although union formation and union separation are common events in reproductive age, little is known about changes in CT risk before and after these transitions. METHODS: We linked Finnish Population Register data to the National Register of Infectious Diseases and used fixed-effects linear probability models that account for all time-invariant confounders to examine changes in women's 6-month CT risk 3 years before and 3 years after entry into first cohabitation (n = 293 554), non-marital separation (n = 201 647) or marital separation (n = 92 232) during 2005-14. RESULTS: From 3 years to 1 year before first union formation, the 6-month risk of CT increased slightly, peaking at 1.27% immediately prior to union formation (95% confidence interval 1.22-1.31). It declined sharply following union formation, being only 0.40% (0.34-0.46) 6-12 months after union formation with little changes thereafter. Among women separating from non-marital unions, the risk increased from 0.50% (0.42-0.57) to 1.45% (1.40-1.49) around the time of separation and decreased following separation. The pattern of findings was relatively similar for marital separation, although the observed risks and changes were smaller in magnitude. CONCLUSIONS: Our results based on longitudinal data and individual fixed-effects models indicate that the period immediately after separation may be causally associated with an elevated risk of CT. This suggests that recently separated women should be identified as a high-risk group for CT.

Changes in parents' psychotropic medication use following child's cancer diagnosis: A fixed-effects register-study in Finland.

BACKGROUND: Symptoms of depression and anxiety are elevated among parents of children with cancer. However, knowledge of parents' psychotropic medication use following child's cancer diagnosis is scarce. METHODS: We use longitudinal Finnish register data on 3266 mothers and 2687 fathers whose child (aged 0-19) was diagnosed with cancer during 2000-2016. We record mothers' and fathers' psychotropic medication use (at least one annual purchase of anxiolytics, hypnotics, sedatives, or antidepressants) 5 years before and after the child's diagnosis and assess within-individual changes in medication use by time since diagnosis, cancer type, child's age, presence of siblings, and parent's living arrangements and education using linear probability models with the individual fixed-effects estimator. The fixed-effects models compare each parent's annual probability of psychotropic medication use after diagnosis to their annual probability of medication use during the 5-year period before the diagnosis. RESULTS: Psychotropic medication use was more common among mothers than fathers already before the child's diagnosis, 11.2% versus 7.3%. Immediately after diagnosis, psychotropic medication use increased by 6.0 (95% CI 4.8-7.2) percentage points among mothers and by 3.2 (CI 2.1-4.2) percentage points among fathers. Among fathers, medication use returned to pre-diagnosis level by the second year, except among those whose child was diagnosed with acute lymphoblastic leukemia or lymphoblastic lymphoma. Among mothers of children with a central nervous system cancer, medication use remained persistently elevated during the 5-year follow-up. For mothers with other under-aged children or whose diagnosed child was younger than 10 years, the return to pre-diagnosis level was also slow. CONCLUSIONS: Having a child with cancer clearly increases parents' psychotropic medication use. The increase is smaller and more short-lived among fathers, but among mothers its duration depends on both cancer type and family characteristics. Our results suggest that an increased care burden poses particular strain to the long-term mental well-being of mothers.

Changing social inequalities in smoking, obesity and cause-specific mortality: Cross-national comparisons using compass typology.

BACKGROUND: In many countries smoking rates have declined and obesity rates have increased, and social inequalities in each have varied over time. At the same time, mortality has declined in most high-income countries, but gaps by educational qualification persist-at least partially due to differential smoking and obesity distributions. This study uses a compass typology to simultaneously examine the magnitude and trends in educational inequalities across multiple countries in: a) smoking and obesity; b) smoking-related mortality and c) cause-specific mortality. METHODS: Smoking prevalence, obesity prevalence and cause-specific mortality rates (35-79 year olds by sex) in nine European countries and New Zealand were sourced from between 1980 and 2010. We calculated relative and absolute inequalities in prevalence and mortality (relative and slope indices of inequality, respectively RII, SII) by highest educational qualification. Countries were then plotted on a compass typology which simultaneously examines trends in the population average rates or odds on the x-axis, RII on the Y-axis, and contour lines depicting SII. FINDINGS: Smoking and obesity. Smoking prevalence in men decreased over time but relative inequalities increased. For women there were fewer declines in smoking prevalence and relative inequalities tended to increase. Obesity prevalence in men and women increased over time with a mixed picture of increasing absolute and sometimes relative inequalities. Absolute inequalities in obesity increased for men and women in Czech Republic, France, New Zealand, Norway, for women in Austria and Lithuania, and for men in Finland. Cause-specific mortality. Average rates of smoking-related mortality were generally stable or increasing for women, accompanied by increasing relative inequalities. For men, average rates were stable or decreasing, but relative inequalities increased over time. Cardiovascular disease, cancer, and external injury rates generally decreased over time, and relative inequalities increased. In Eastern European countries mortality started declining later compared to other countries, however it remained at higher levels; and absolute inequalities in mortality increased whereas they were more stable elsewhere. CONCLUSIONS: Tobacco control remains vital for addressing social inequalities in health by education, and focus on the least educated is required to address increasing relative inequalities. Increasing obesity in all countries and increasing absolute obesity inequalities in several countries is concerning for future potential health impacts. Obesity prevention may be increasingly important for addressing health inequalities in some settings. The compass typology was useful to compare trends in inequalities because it simultaneously tracks changes in rates/odds, and absolute and relative inequality measures.

The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking.

INTRODUCTION: This study assesses the effects of obesity, physical inactivity and smoking on life expectancy (LE) differences between educational groups in five European countries in the early 2000s. METHODS: We estimate the contribution of risk factors on LE differences between educational groups using the observed risk factor distributions and under a hypothetically more optimal risk factor distribution. Data on risk factor prevalence were obtained from the Survey of Health, Ageing and Retirement in Europe study, and data on mortality from census-linked data sets for the age between 50 and 79 according to sex and education. RESULTS: Substantial differences in LE of up to 2.8 years emerged between men with a low and a high level of education in Denmark, Austria and France, and smaller differences among men in Italy and Spain. The educational differences in LE were not as large among women. The largest potential for reducing educational differences was in Denmark (25% among men and 41% among women) and Italy (14% among men). CONCLUSIONS: The magnitude of the effect of unhealthy behaviours on educational differences in LE varied between countries. LE among those with a low or medium level of education could increase in some European countries if the behavioural risk factor distributions were similar to those observed among the highly educated.

Living arrangements and external causes of deaths in early adulthood.

PURPOSE: The mortality-lowering benefits of living in a union are well-known in the adult population, but the association between living arrangements and mortality among the young remains unclear. This study examines the association between current living arrangements and external causes of death in early adulthood, adjusting for factors such as parental socioeconomic position, current main activity, household income, and level of own education. METHODS: The study is based on annually updated longitudinal register data that include a representative 11% sample of the whole Finnish population with an over-sample of 80% of all deaths. We used mortality rates and Cox proportional hazards models to study deaths in young adults aged between 17 and 29 years of age, from 1995 to 2004. RESULTS: Compared with living in parental home with married parents, those living alone in late teens and early 20s had clearly higher risk of external mortality among both sexes. Young adults living in cohabiting- or one-parent families carried likewise a higher risk of death. Living with a partner was associated with lower mortality in early 20s, but especially in late 20s. The observed mortality differentials by living arrangements remained notable for the most part, even after adjustment for socioeconomic factors. CONCLUSIONS: Strong excess mortalities among those living alone, single parents, children of single and cohabiting parents, the nonemployed, the less educated, and the less earning highlight the importance of late adolescence and early adulthood as a critical period for emerging health inequalities.

Chronic conditions and the risk of long-term institutionalization among older people.

BACKGROUND: As the public expenditure on long-term care is likely to increase with the ageing of the population, identifying chronic medical conditions associated with the risk of long-term institutionalization is of particular interest. However, there is little systematic evidence showing how chronic medical conditions, other than dementia, affect the risk of entering into institutional care in the general older population. METHODS: We used population-based follow-up data on Finnish older people aged 65 and over (n = 280 722), to estimate the impact of different chronic conditions on the risk of long-term institutionalization. Furthermore, we analysed which chronic conditions were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Cox proportional hazard regression models were used. RESULTS: Our results showed that dementia, Parkinson's disease, stroke, depressive symptoms, other mental health problems, hip fracture and diabetes were strongly associated with increased risk of long-term institutionalization, independent of socio-demographic confounders and the presence of other chronic conditions. All these conditions raised the risk of institutionalization by 50% or more. Dementia, Parkinson's disease, stroke and mental health problems were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. CONCLUSIONS: Overall, these results show that the future demand for institutional care depends not only on the ageing of the population but also on the development of the prevalence and severity of chronic conditions associated with institutionalization.

Socioeconomic differences in suicide mortality by sex in Finland in 1971-2000: a register-based study of trends, levels, and life expectancy differences.

AIM: Suicide is a common cause of death in many Western countries and it has been predicted to become even more common worldwide. The authors analysed socioeconomic differences and trends in Finnish suicide mortality, and assessed the relevance to public health by calculating socioeconomic differences in years of life expectancy lost attributable to suicide. DATA AND METHODS: Census records were used, linked with the death records of men and women aged 25 years and over in 1971-2000 in Finland. RESULTS: Suicide among male and female manual workers was 2.3 and 1.3 times higher respectively than among upper non-manual workers. The differences were largest among those in their thirties. Because of the decline in suicide among upper non-manual workers and a slower decrease or even an increase among other socioeconomic groups, the relative mortality differences increased somewhat during 1970-90, then decreased in the 1990s but remained higher than in the 1970s. In 1991-2000 the suicide-related life expectancy gap between the upper non-manual and manual male workers was 0.6 years, and this difference contributed 10% to the total difference in years of life expectancy lost between these socioeconomic groups. CONCLUSION: Large and persistent socioeconomic differences were found in suicide mortality and suicide was an important component of the socioeconomic difference in total mortality. Reducing these differences could significantly improve equity in health and reduce the burden of excess mortality.

Official marital status, cohabiting, and self-rated health-time trends in Finland, 1978-2001.

BACKGROUND: Married persons are healthier and live longer than single, divorced, and widowed persons. Time trends in self-rated health (SRH) by marital status and cohabitation have remained largely unstudied. We aim to assess the levels and trends of SRH by official marital status and cohabitation, and to study the causes of these differences. METHODS: Two nationally representative cross-sectional surveys were conducted 20 years apart in Finland. Data on self-reported marital status, SRH, education, smoking, and long-standing illness were collected from Finns aged 30-64 years in 1978-80 (Mini-Finland Health Survey, N = 6102, response rate 96%) and 2000-01 (Health 2000 Survey, N = 5871, response rate 92%). RESULTS: SRH has improved in the last 20 years, but differences between marital status groups have not reduced. In 2000-01, non-married persons reported worse SRH than married persons. Among men, single [cumulative odds ratio (COR) = 1.55; 95% confidence interval (95% CI) 1.22-1.99] and divorced (COR = 1.55; 95% CI 1.17-2.05) persons showed the poorest SRH, while among women widows (1.53; 95% CI 1.04-2.26) were the most disadvantaged group. The SRH of cohabiting persons did not significantly differ from that of married persons. Differences in educational structure, smoking, and the prevalence of long-term illness explain part of the marital status differences in SRH among men, but less so among women. Among both single men and women as well as among widowed women, SRH had improved slightly less than in the other groups. CONCLUSION: The challenges on public health posed by growing numbers of currently not married people are likely to increase.