Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition

Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities ove...

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Main Authors: Ulla Suulamo, Lasse Tarkiainen, Hanna Remes, Pekka Martikainen
Format: Article
Language:English
Published: Elsevier 2021-09-01
Series:SSM: Population Health
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2352827321001257
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spelling doaj-b8923b3691654e6aa7f1ac244d7c1c712021-10-01T05:01:54ZengElsevierSSM: Population Health2352-82732021-09-0115100850Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population compositionUlla Suulamo0Lasse Tarkiainen1Hanna Remes2Pekka Martikainen3Corresponding author.; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Unioninkatu 35 (P.O. Box 18), FIN-00014, Helsinki, FinlandPopulation Research Unit, Faculty of Social Sciences, University of Helsinki, Unioninkatu 35 (P.O. Box 18), FIN-00014, Helsinki, FinlandPopulation Research Unit, Faculty of Social Sciences, University of Helsinki, Unioninkatu 35 (P.O. Box 18), FIN-00014, Helsinki, FinlandPopulation Research Unit, Faculty of Social Sciences, University of Helsinki, Unioninkatu 35 (P.O. Box 18), FIN-00014, Helsinki, FinlandExisting evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.http://www.sciencedirect.com/science/article/pii/S2352827321001257MortalityHealth inequalitiesRegional variationLong-term trendsMultilevel modelling
collection DOAJ
language English
format Article
sources DOAJ
author Ulla Suulamo
Lasse Tarkiainen
Hanna Remes
Pekka Martikainen
spellingShingle Ulla Suulamo
Lasse Tarkiainen
Hanna Remes
Pekka Martikainen
Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
SSM: Population Health
Mortality
Health inequalities
Regional variation
Long-term trends
Multilevel modelling
author_facet Ulla Suulamo
Lasse Tarkiainen
Hanna Remes
Pekka Martikainen
author_sort Ulla Suulamo
title Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
title_short Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
title_full Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
title_fullStr Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
title_full_unstemmed Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition
title_sort changes in regional variation in mortality over five decades – the contribution of age and socioeconomic population composition
publisher Elsevier
series SSM: Population Health
issn 2352-8273
publishDate 2021-09-01
description Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.
topic Mortality
Health inequalities
Regional variation
Long-term trends
Multilevel modelling
url http://www.sciencedirect.com/science/article/pii/S2352827321001257
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