PARALLEL SESSION A Track A1: Determinants of mortality

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]
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.
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.
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.
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
Section of Epidemiology and Public Health, University ‘G. d’Annunzio’ of
Chieti, Italy
Section of Clinical Medicine and Public Health, Department of Experimental
Medicine and Pathology, University ‘La Sapienza’, Roma, Italy
Italian Institute of Social Medicine, Rome, Italy
*Contact details: [email protected]
A relationship between marital status and mortality has long
been recognized. However, no precise estimates of the strength
of the association are available.
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.
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).
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
Department of Social and Preventive Medicine, University of Berne,
Department of Social and Preventive Medicine, University of Zurich,
*Contact details: [email protected]
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.
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.
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.
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
MRC Social and Public Health Sciences Unit, Glasgow, UK
Research Unit in Health, Behaviour and Change, Edinburgh, UK
*Contact details: [email protected]
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.
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).
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.
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
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
London School of Hygiene and Tropical Medicine, London, UK
Izhevsk Medical Academy, Izhevsk, Russia
Social Technologies Institute, Izhevsk State Technical University,
Izhevsk, Russia
Max Planck Institute for Demographic Research, Rostock, Germany
*Contact details: [email protected]
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.
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.
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
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.