PARALLEL SESSION A Thursday 16 November, 13:30–15:00 Track A1: Determinants of mortality—epidemiology Did insecure employment contribute to mortality in post-transition Russia? Francesca Perlman FJA Perlman*, M Bobak London School of Hygiene and Tropical Medicine, London, UK *Contact details: [email protected] Background The fall of Communism in Russia in 1991 was followed by socioeconomic instability and an unprecedented increase in mortality, particularly amongst the least educated. Insecure employment, a known determinant of health, was widespread during this time, but its role in the Russian mortality crisis has not been studied. I aimed to describe insecure employment in post-transition Russia, and whether it predicted mortality or explained the socioeconomic mortality gradient. Methods Data from seven rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a multi-centre panel study, were used. Employed respondents aged over 18 were studied. Deaths reported by a household member, wage arrears, compulsory leave, payment in goods, education (three categories), and occupation (five categories) were measured. Relationships between education, occupation, and unstable employment were studied. Cox proportional hazards analysis was used to study the association between measures of job insecurity and mortality, and whether insecure employment explained the occupational and educational mortality gradients. Results Data for 3498 (51.7%) males and 3274 (48.3%) females were analysed: 193 men and 38 women died. More than one-third of respondents experienced wage arrears, and 10% experienced compulsory leave and payment in consumer goods. Insecure employment fluctuated over time with changes in macroeconomic measures, and was more common in less educated individuals and in manual workers. Mortality was significantly associated with payment in consumer goods in men [1.72 (1.20–2.49)], and with compulsory unpaid leave in women [30 days or less: 2.57 (1.06–6.22); more than 30 days: 5.65 (2.17–14.69)]. Wage arrears did not predict mortality. Significant mortality gradients in relation to occupation and education were not explained by insecure employment. Conclusions Job insecurity was widespread in post-transition Russia, especially amongst disadvantaged groups. Measures of insecure employment predicted death somewhat inconsistently, however, and did not explain the socioeconomic gradient in mortality. Marital status and mortality in the elderly: a systematic review and meta-analysis Lamberto Manzoli L Manzoli1*, A Boccia2, GM Pirone3, P Villari2 1 Section of Epidemiology and Public Health, University ‘G. d’Annunzio’ of Chieti, Italy 2 Section of Clinical Medicine and Public Health, Department of Experimental Medicine and Pathology, University ‘La Sapienza’, Roma, Italy 3 Italian Institute of Social Medicine, Rome, Italy *Contact details: [email protected] Background A relationship between marital status and mortality has long been recognized. However, no precise estimates of the strength of the association are available. Methods A meta-analysis of cohort studies was conducted to produce an overall estimate of the excess mortality associated with being unmarried in aged individuals as well as to evaluate whether and to what degree the effect of marriage differs with respect to gender, geographical/cultural context, type of non-married condition, and methodological quality of studies. To be included, studies had to be published after the year 1994 and use multivariate techniques in the analysis. Results Twenty-nine papers, for a total of 53 independent comparisons, consisting of more than 250 000 older subjects, were included in the main meta-analysis assessing the risk of death of married versus non-married individuals (including widowed, divorced/ separated, and never married). Using the random-effect generic inverse variance approach, the overall Relative Risk (RR) for married persons was 0.88 [95% Confidence Interval (CI): 0.85–0.91]. This estimate did not vary by gender, geographical context, and study quality. Compared with married individuals, widowed individuals had an RR of death of 1.11 (1.08–1.14), while the RR of divorced/separated was 1.16 (1.09–1.23) and that of never married was 1.11 (1.07–1.15). Although some evidence of publication bias was found, the overall estimate of effect of marriage was robust to several statistical approaches and sensitivity analyses. When the overall meta-analysis was repeated with an extremely conservative approach and including eight non-significant comparisons, that were initially excluded because of data unavailable, marriage protective influence remained significant, although the effect size was reduced (RR ¼ 0.94; 0.92–0.95). Conclusions Although the methodological limitations of this analysis have to be taken into account, these findings might be important to support health care providers in identifying individuals ‘at risk’ and could be integrated into the current programmes of mortality-risk estimation for the elderly. Religion and suicide in German-speaking part of Switzerland—Swiss National Cohort Adrian Spoerri A Spoerri1*, M Bopp2, M Zwahlen1, F Gutzwiller2, M Egger1 1 Department of Social and Preventive Medicine, University of Berne, Switzerland 2 Department of Social and Preventive Medicine, University of Zurich, Switzerland *Contact details: [email protected] Background Suicide is one of the leading injury-related causes of death worldwide. In the second half of the past century, suicide rates grew in Europe and worldwide, although a recent decline has been found in several European countries since about 1985, with the exception of the former GUS states. More than 100 years ago Durkheim argued that suicide is a primarily social, not an individual, problem documenting this with the lower suicide rates in catholic than protestant cantons in Switzerland. This study aimed at reassessing the influence of individual religious affiliation on suicide. Methods The Swiss National Cohort linked the records from the 4 December 1990 census with death certificate data up to 1997. The current analysis was restricted to Swiss nationals in 14th Annual EUPHA Meeting: Parallel Session A, Thursday 16 November, 13:30–15:00 the German speaking part of the country. A total of 4096 suicides occurred in 20.1 million person-years. The association of individual religious affiliation on suicide was examined using Cox regression models, controlling for age, marital status, socioeconomic position (here education), size of municipality, and effects of main confession of the municipality. Results Suicide rates were lower for Catholics than Protestants: at age 25 the hazard rate was 0.85 (95% CI 0.74–0.99) and declined progressively to 0.35 (95% CI 0.21–0.59) at age 85. Younger people did not profit from their catholic religion anymore when living in municipalities with neither catholic nor protestant majority. Conclusions Religious affiliation still affects suicide rates in Switzerland, especially among the elderly. As catholic regions tend to be more rural than protestant the effect of religion could be interpreted as effect of different social structures and socioeconomic development. Public health interventions on suicide should address the social capital of the regional unit in focus. Sex, gender role orientation, gender role attitudes, and suicidal thoughts in three generations: a general population study Kate Hunt K Hunt1*, H Sweeting1, S Platt2 1 MRC Social and Public Health Sciences Unit, Glasgow, UK 2 Research Unit in Health, Behaviour and Change, Edinburgh, UK *Contact details: [email protected] Background Suicide and other suicidal behaviours are markedly (though differently) patterned by gender. The increase in young male suicide rates in many countries has heightened interest in whether suicidal behaviours and ideation are related to masculinity. Little research has explored the relationship between gender role attitudes and orientation, and suicidal behaviours and ideation. Most research in this area has been conducted with young people. Methods Subjects (653 men and women aged around 23 years, 754 aged around 43 years, 722 aged around 63 years) completed home interviews with nurses as part of an ongoing longitudinal community-based study of social factors and health. These included measures of suicidal ideation (thoughts), attitudes to traditional gender roles, and a validated measure of gender role orientation (masculinity and femininity scores). Results The prevalence of serious suicidal thoughts was higher in early adulthood (10% men, 15% women) than in early (4% men, 8% women) and late (6% men, 5% women) middle age. In early adulthood only sex was significantly related to suicidal thoughts, with women at higher risk (adjusted OR 1.74, 95% CI 1.01– 3.00). In early middle age masculinity scores were negatively related to suicidal thoughts (adjusted OR for each unit increase in score 0.65, 95% CI 0.46–0.93), and more traditional views on gender roles were positively associated with suicidal thoughts (adjusted OR 1.48, 95% CI 1.07–2.04). In late middle age trends were in the same direction as in early middle age but were not statistically significant. Femininity scores were unrelated to serious suicidal thoughts at any age. 9 Conclusions The high rates of suicidal thoughts amongst men and women in early adulthood point to the importance of understanding mental health problems at this age. The results raise a number of questions and suggest that suicide researchers should pay more attention to gender roles and attitudes in older adults. Alcohol and premature mortality in Russia: the Izhevsk Family case–control study of men aged 25–54 years, 2003–2005 Susannah Tomkins S Tomkins1*, DA Leon1, N Kiryanov2, LA Saburova3, E Andreev4, M Mckee1, V Shkolnikov4 1 London School of Hygiene and Tropical Medicine, London, UK 2 Izhevsk Medical Academy, Izhevsk, Russia 3 Social Technologies Institute, Izhevsk State Technical University, Izhevsk, Russia 4 Max Planck Institute for Demographic Research, Rostock, Germany *Contact details: [email protected] Background Analysis of cause-specific mortality data supplemented by crosssectional survey data and indirect alcohol consumption estimates suggest that alcohol-consumption patterns partly explain fluctuations in the very high mortality among working-age men in Russia over the past two decades. We report results of the first large-scale individual-level study to examine the contribution of alcohol in this context. Methods Interviews were conducted with proxy informants living in the same household as 1750 (case) men who died in Izhevsk (a typical medium-sized Russian city in the Urals) and proxy informants of 1750 live (control) men aged 25–54 years. Results Drinking vodka and other beverage spirits several times a week or more led to a moderate increase in all-cause mortality. Mortality was most strongly associated with the consumption of surrogate alcohols (manufactured alcohol-containing nonbeverage substances such as eau de cologne, often over 90% ethanol by volume). Among controls, 7% had drunk surrogates in the past year. The mortality odds ratio (MOR) for ever versus never drinking surrogates was 6.12 (95% CI 4.88–7.66) adjusted for smoking, educational level, and alcoholic beverage consumption. Death from some specific causes showed considerably larger effects: the adjusted MOR for all causes classified as alcohol-related was 20.5 (95% CI 14.5–28.8). Surrogate drinking frequency showed a strong dose–response effect: adjusted all-cause MOR for drinking surrogates at least 5 days a week versus not drinking surrogates was 11.5 (95% CI 8.05–16.6). The population attributable risk percentage for all-cause mortality associated with surrogates was 34%. This is likely to underestimate the total population burden due to hazardous drinking. Conclusions Surrogate drinking is likely to be a marker of a history of heavy and hazardous drinking of any form of alcohol. However, our results suggest that the consumption of surrogate alcohols may be particularly dangerous and account for much of the male excess mortality at working ages in Russia.