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Original research
Contribution of causes of death to changing inequalities in life expectancy by income in Finland, 1997–2020
  1. Lasse Tarkiainen1,2,
  2. Pekka Martikainen1,2,3,
  3. Liina Junna1,2,
  4. Hanna Remes1,2
  1. 1 Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  2. 2 Max Planck – Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
  3. 3 Max-Planck-Institute for Demographic Research, Rostock, Germany
  1. Correspondence to Dr Lasse Tarkiainen, Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Uusimaa, Finland; lasse.tarkiainen{at}helsinki.fi

Abstract

Background Socioeconomic inequalities in mortality originate from different causes of death. Alcohol-related and smoking-related deaths are major drivers of mortality inequalities across Europe. In Finland, the turn from widening to narrowing mortality disparities by income in the early 2010s was largely attributable to these causes of death. However, little is known about recent inequalities in life expectancy (LE) and lifespan variation.

Methods We used individual-level total population register-based data with annual information on disposable household income and cause-specific mortality for ages 30–95+, and assessed the contribution of smoking on mortality using the Preston-Glei-Wilmoth method. We calculated trends in LE at age 30 and SD in lifespan by income quintile in 1997–2020 and conducted age and cause-of-death decompositions of changes in LE.

Results Disparity in LE and lifespan variation by income increased in 2015–2020, largely attributable to the stagnation of both measures in the lowest income quintile. The LE gap between the extreme quintiles in 2018–2020 was 11.2 (men) and 5.9 (women) years, of which roughly 40% was attributable to alcohol and smoking. However, the recent widening of the gap and the stagnation in LE in the lowest quintile over time were not driven by any specific cause-of-death group.

Conclusions After a decade of narrowing inequalities in LE and lifespan variation in Finland, the gaps between income groups are growing again. Increasing LE disparity and stagnating mortality on the lowest income levels are no longer attributable to smoking and alcohol-related deaths but are more comprehensive, originating from most cause-of-death groups.

  • mortality
  • smoking
  • health inequalities
  • alcoholism

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to confidentiality reasons. Individual register data are available for reseach purposes upon request to Statistics Finland.

https://doi.org/10.1136/jech-2023-221705

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    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to confidentiality reasons. Individual register data are available for reseach purposes upon request to Statistics Finland.

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    Footnotes

    • Contributors LT, PM, LJ and HR contributed to the conception and design of the study. PM acquired the data. LT analysed the data and drafted the manuscript. LT, PM, LJ and HR contributed substantially to designing the final analyses. LT, PM, LJ and HR revised critically the drafts and the final manuscript for important intellectual content and approved the version published. LT is the guarantor.

    • Funding The study was supported by the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 101019329), the Strategic Research Council (SRC) within the Academy of Finland grants for ACElife (#352543-352572) and LIFECON (#308247), and grants to the Max Planck–University of Helsinki Center from the Jane and Aatos Erkko Foundation (#210046), the Max Planck Society (# 5714240218), University of Helsinki (#77204227) and Cities of Helsinki, Vantaa and Espoo.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.