Väestötiede ja kvantitatiivinen sosiaalitutkimus

Esitys aiheesta: "Väestötiede ja kvantitatiivinen sosiaalitutkimus"— Esityksen transkriptio:

1 Väestötiede ja kvantitatiivinen sosiaalitutkimus
Pekka Martikainen

2 Laitoksella tehtävästä kvantitatiivisesta tutkimuksesta
Kvantitatiivista tutkimusta tehdään laitoksessa useassa tutkimusryhmässä Kuolleisuus- ja terveystutkimus Ikääntyvän väestön tutkimus Kaupunkitutkimus (aluetutkimus) Kvantitatiivinen perhetutkimus (Jalovaara) Namibia/Afrikka-tutkimus (Shemeikka)

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

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

5 Vanheneva väestö asuinolot ja köyhyys perherakenne, yksin eläminen, avoliitto epävirallinen hoiva ja sukulaissuhteet elämätapahtumat ja niiden seuraukset sairastuminen leskeytyminen laitostuminen perhevaikutukset terveydessä

6 Types of data sources Individual level data on the Finnish population 1970+ Based on Censuses from (every 5-years) Population registration (annual) Linked with data on e.g. Mortality, hospital discharge and medication Taxation Establishment records Contextual information (eg. area) Linkage is based on social security numbers Allows: Longitudinal analyses Identify couples/households

7 … continued 10% sample of the 1950 census Based on
1950 Census (household based) Population census and registration from 1970 onwards Expanding family study

8 … 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

9 Vanhusten asumismuotojen muutos, laitoshoito ja epävirallinen hoiva

10 Population projection 2003-2040 by age

11 Sources of care Formal care ~ care from the public sector / paid care from the private sector care in the community institutional care Informal care ~ ’help from family, friends and relatives’

12 Main sources of support and help among 75
year old men and women in Finland (%) living in the community Men Women Spouse 57 34 Children 33 42 Other relatives/friends 37 31 Formal support 8 11 % does not add up 100 as support can be obtained simultaneously from several sources

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

14 Change in Population 75+ 2001 to 2031

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

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

18 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

19 An example of data content for a study of entry into institutional care
STAKES Use of homecare services Institutional care: Care episodes Date of entry Date of exit Type of institution Sociodemographic factors: Sex, sex Marital status Living arrangements Education Social class Income Housing Partner Region Date/cause of death STAKES Supply of care: Regional coverage of institutional care Pension institute Health: Medication Hospital discharge STAKES StatisticsFinland STAKES

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

21 Institutionalisation among Finnish men and women aged 65+; hazard ratios

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

23 Figure 1. Relative age-adjusted institutionalization rates in relation to duration of bereavement, Finnish elderly 65+ (Reference = married) Nihtilä and Martikainen, 2006

24 Hazard ratios (women vs
Hazard ratios (women vs. men) of institutionalisation and mode of exit from institution Martikainen, Moustgaard, Murphy, Nihtilä, Koskinen, Martelin, Noro, The Gerontologist 2008

25 = > Adjusted for age: Women stay in care on average days - if living with spouse at baseline 994 days - if living alone at baseline days Men stay in care on average days - if living with spouse at baseline 645 days - if living alone at baseline days

26 Kuolleisuus- ja terveyserot

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31 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

32 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

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

34 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)

35 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 health curvi-linear linear

36 Age adjusted and fully adjusted hazard ratios of mortality by different measures of income. Women aged 30-64 ---- Adjusted for age ---- Adjusted for age, educational attainment, occupational social class and economic activity

37 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

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40 Women poorest 20% Women richest 60% Women mid 60% Men poorest 20% Men richest 20% Men mid 60%

41 Työttömyys ja kuolleisuus

42 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

43 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 stress Tobacco and alcohol consumption Loss 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.

44 Figure 1. Possible pathways between unemployment, job insecurity and health
Martikainen and Ferrie: Encyclopedia of Public Health, 2008

45 Martikainen; BMJ, 1990

46 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

47 Figure 2. Mortality by cause and self-inflicted injury leading to hospital admission in following plant closure in New Zealand meat processing workers. Keefe et al. IJE, 2002

48 Unemployment rate by sex
Women Source: Martikainen&Valkonen 1995

49 Age-adjusted mortality (deaths/100
Age-adjusted mortality (deaths/ )) for selected accidental and violent causes of death , year-old men and women (two year moving averages) Men Women Suicide Suicide Other accidents Motor vehicle accidents Motor vehicle accidents Other accidents Poisonings Poisonings Source: Martikainen&Valkonen 1995

50 Table 2. Adjusted mortality ratios
Table 2. Adjusted mortality ratios* by employment status among year-old Finnish men and women *Adjusted for age, education, occupational class and marital status Martikainen ánd Valkonen, Lancet, 1996

51 Martikainen, Mäki and Jäntti

52 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.

53 Asuinalueen ominaisuudet ja terveys

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56 Siviilisääty, asumisjärjestelyt ja terveys

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62 Alkoholin hinnanmuutosten vaikutukset kuolleisuuteen

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

64 Annual number of alcohol-related deaths due to major causes before (=blue) and after (= red) the price reduction 39 13 14 25 1 23 12 -13 20 Herttua K, Mäkelä P, Martikainen P. American Journal of Epidemiology 2008

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

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

67 Graduaiheita Joitain 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’

68 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