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  • Title: Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study.
    Author: Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Leinsalu M.
    Journal: Addiction; 2021 Dec; 116(12):3357-3368. PubMed ID: 33908662.
    Abstract:
    AIM: To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland. DESIGN: Longitudinal register-based follow-up study. SETTING: Estonia, Latvia, Lithuania and Finland. PARTICIPANTS: General population in the 35-74 age group. MEASUREMENTS: Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality. FINDINGS: Alcohol-related mortality increased in all countries in 2004-2007 except among Estonian women and decreased/remained the same from 2008 onward except among Latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 versus 2000-2003 in all countries except Estonia (decrease). CONCLUSION: In the Baltic countries and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and decrease more among the high educated during a period of economic recession (2008-2011).
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