Hypertension, hypercholesterolaemia and diabetes mellitus are major risks for cardiovascular and cerebrovascular disease mortality and morbidity all over the world. The prevalence of these conditions is high and it continues to climb, as a result of aging population and rising obesity rates. Antihypertensive, lipid-lowering, and hypoglycemic medications are important tools for reducing cardiovascular and cerebrovascular risk. However, it has been suggested that poor adherence to a medication regimen significantly hampers the effectiveness of these medications, although few large-scale population-wide studies are available to substantiate this hypothesis. Thus, the overarching aims of this study is to (i) examine the extent to which the degree of adherence to antihypertensive, lipid-lowering, and hypoglycemic therapy is associated with mortality and morbidity endpoints and (ii) identify factors that are likely to increase or decrease adherence at a population level. The analyses are based on the nationwide registration of drugs, hospitalization and causes of death in Finland.

Key words: hypertension, hypercholesterolaemia, diabetes mellitus, adherence to drug therapy, cardiovascular diseases, cerebrovascular diseases, mortality, morbidity

Researcher: Kimmo Herttua

Alcohol misuse was ranked in the top three risk factors for global disease burden in 2010. Pricing and availability of alcohol have been regarded as effective tools in reducing harm. Changes in alcohol prices have been documented to be inversely associated with changes in consumption and alcohol-related harm. Much of the evidence on this issue is based on cross-sectional state-level time series data and natural experiments have been called for. The changes in Finnish alcohol legislation that occurred in 2004 can be considered as a natural experiment. In the European context, research on the association between prices of alcohol and alcohol-related harm is scarce or non-existent. The objectives of this study are (i) to estimate the impact of changes in alcohol policy of  2004 in Finland on alcohol-related, cardiovascular and all-cause mortality, hospitalization related to alcohol, and interpersonal violence according to a wide range of socio-demographic indicators and (ii) to estimate effects of affordability of alcohol and minimum prices of alcohol on alcohol-related mortality and morbidity according to different socio-demographic indicators   The analyses are based on the nationwide registration of hospitalization, causes of death and crimes, and information on alcohol prices and socio-demographic indicators in Finland and other EU countries.

Key words: alcohol drinking, alcohol misuse, price of alcohol, natural experiment, mortality, morbidity, socio-demographic inequalities

Researcher: Kimmo Herttua

It is known that many different factors play a role in leisure-time physical activity behavior. However, a consensus of the factors involved in leisure-time physical activity behavior has not been reached. Genetic studies are a new area of physical activity research. Motives for physical activity have been widely studied but longitudinal studies are still missing. The purpose of this project was to quantify longitudinally genetic and environmental influences on leisure-time physical activity and to examine the associations between motives and longitudinal leisure-time physical activity. The results of the latest longitudinal Finnish twin studies point to the existence of age-specific genetic and environmental influences on leisure-time physical activity. Variations in environmental factors seem to explain the observed deterioration in leisure-time physical activity levels. A decline in genetic influences is seen first from adolescence to young adulthood and again from the age of thirty to the mid-thirties. In the Finnish twin participants, mastery, physical fitness, and psychological state were the major motivation factors associated with consistent leisure-time physical activity behavior. The results also indicate that intrinsic motivation factors may be important for engagement in leisure-time physical activity.

Researcher: Sari Aaltonen

With growing pressure from an ageing population on social and health-care expenditure, it is of major policy importance to analyze the reasons for admission to institutional care at older ages. This study focuses on how different chronic medical conditions, socio-economic factors, living with a spouse, and the death of a spouse are associated with admission among people aged 65 years or older. The findings in this study imply that the future need for institutional care will depend not only on the increasing numbers of older people but also on the development of the prevalence and severity of chronic medical conditions associated with admission, and on older people’s income, housing conditions and access to informal care from their spouse.

Key words: nursing home, institution, long-term care, elderly, socioeconomic position, widowhood, bereavement

Researcher: Elina Einiö

Childhood is a critical phase of life for the formation of the further health risk factor profile. We found that childhood physical development is strictly genetically regulated in several Western (Finnish, Swedish, Danish, Dutch, and US) populations, and genetic factors affect strongly also on cognitive and other mental development. This regulation is also very similar in Japanese and Chinese populations in spite of large ethnic and environmental differences to Western populations. Childhood social environment was found to modify the effects of genetic and environmental factors. Physical development in childhood was associated with metabolic risk factor profile and risk of metabolic diseases in adulthood. At the moment the main focus is to understand better how physical development is associated with mental development in childhood and how societal macro environment modifies the role of genetic and environmental factors behind the physical development of the child.

Key words: childhood, physical development, mental development, genetics, ethnicity, international comparisons

Researchers: Karri Silventoinen and Aline Jelenkovic

Across societies, poor mental and physical health and excess mortality are consistently linked to union dissolution. This project examines the complex interplay between union stability and health. The findings suggest that mental health is more closely linked to union stability than to whether the union is marital or not. Poor mental health seems to put strain on unions and hinder the formation of long-term unions, suggesting mental healthcare should focus more on relationship dynamics. Psychological support during separation is also needed to avoid high-risk health behaviors, such as alcohol use as a coping mechanism.

Key words: mental health, divorce, marriage, marital transitions, non-marital transitions, cohabitation, separation, psychotropic medication, mortality

Researcher: Niina Metsä-Simola, Heta Moustgaard

Key publications:

Metsä-Simola, N., Martikainen, P. & Monden, C.W. (2018). Psychiatric morbidity among middle-aged Finnish couples and the risk of subsequent divorce. Social Psychiatry and Psychiatric Epidemiology 53(8):823-831.

Metsä-Simola, N. & Martikainen, P. (2014). The effects of marriage and separation on the psychotropic medication use of non-married cohabiters: A register-based longitudinal study among adult Finns. Social Science & Medicine 121:10-20.

Metsä-Simola, N. & Martikainen, P. (2013). Divorce and changes in the prevalence of psychotropic medication use: a register-based longitudinal study among middle-aged Finns. Social Science & Medicine 94:71-80.

Metsä-Simola, N. & Martikainen, P. (2013). The short-term and long-term effects of divorce on mortality risk in a large Finnish cohort, 1990-2003. Population Studies, 67 (1):97-110.

Monden, C.W., Metsä-Simola, N., Saarioja, S. & Martikainen, P. (2015). Divorce and subsequent increase in uptake of antidepressant medication: a Finnish registry-based study on couple versus individual effects. BMC Public Health 15:158.

Silventoinen, K., Moustgaard, H., Peltonen, R. & Martikainen, P. (2013). Changing associations between partnership history and risk of accidents, violence and suicides. Journal of Epidemiology & Community Health. 67, 3, 265-270.

Torssander, J., Moustgaard, H., Peltonen, R., Kilpi, F. & Martikainen, P. (2018). Partner resources and incidence and survival in two major causes of death. SSM – Population Health, 271-279.

van Hedel, K., Martikainen, P., Moustgaard, H. & Myrskylä, M. (2018). Cohabitation and mental health: Is psychotropic medication use more common in cohabitation than marriage? SSM – Population Health, 244-253.

The overall aim of this EU Horizon2020 funded comparative project is to identify the opportunities offered by the urban environment for the promotion of mental wellbeing and cognitive function of older individuals in Europe. To achieve this, the project will advance understanding by bringing together longitudinal studies across cities in Europe, the US and Canada to unravel the causal pathways and multi-level interactions between the urban environment and the individual determinants of mental wellbeing in older age. The project will examine the causes of variation in mental wellbeing and disorders in old age both within as well as between cities and identify national and urban policies for the prevention and early diagnosis of mental conditions and disorders of older people. This knowledge will contribute to the establishment of preventive strategies in urban settings to promote the mental dimension of healthy ageing, reduce the negative impact of mental disorders on co-morbidities and preserve cognitive function in old age. The specific objectives of MINDMAP are:

  1. To assess the impact of the urban environment on the mental wellbeing and disorders associated with ageing, and estimate the extent to which exposure to specific urban environmental factors and policies explain differences in ageing-related mental and cognitive disorders both within as well as between European cities. The project will assemble and harmonize data from 10 ongoing longitudinal ageing studies across more than 16 cities in Europe, Canada and the United States. This will be complemented by registry data on mortality and hospital discharge, as well as international longitudinal surveys of ageing.
  2. To assess the causal pathways and interactions between the urban environment and the individual determinants of mental health and cognitive ageing in older adults. We will test the hypothesis that mental health and cognitive capacity in old age are shaped by the interaction between specific characteristics of the urban environment and social, biological, behavioural, and psychosocial characteristics. Our study will also asses the interaction between the urban environment and the genetic make-up.
  3. To use agent-based modelling to simulate the effect of prevention and early identification policies specific to urban environments on the trajectories of mental health and cognitive ageing across cities in Europe. Integrating findings from the first two aims into a novel agent-based model, we will use a systems approach to simulate the potential impact of multiple policy and intervention scenarios on the mental and cognitive wellbeing of older populations in European cities.

To achieve these aims, we adopt an interdisciplinary approach that integrates insights and methodological approaches from mental health and psychiatry, biology, epidemiology, epigenetics, geriatrics, geography and social sciences. To achieve impact, we model the impact of concrete features of the urban environment, policies and interventions on common mental health disorders in European cities. We involve a wide number of stakeholders at the regional, national and European level to translate knowledge into practice. A major legacy of the project will be a research infrastructure of harmonized international urban cohort studies of ageing and mental health. This infrastructure will advance the study of the interactions between contextual exposures in the urban environment and individual determinants of mental health and cognitive ageing within and beyond the MINDMAP project.

MINDMAP projet homepage

Researchers: Lasse Tarkiainen, Kaarina Korhonen, Heta Moustgaard

Rapid increase in the standard of living, unparalleled to any phase of human history, has leaded to dramatic increase of obesity and metabolic diseases in western societies. Genetic factors explain important part of the individual differences in body mass index and their role increases from childhood to adulthood. Genetic factors can also be found behind eating behavior and other risk factors of obesity. However socio-economic factors and cognitive ability are also associated with obesity and metabolic diseases. Genetic and environmental factors interact and their effects on metabolic factors vary between different social contexts. In the future we aim to study the complex relationships between genetic factors, socio-economic micro-environment and societal macro-environment in the formation of metabolic disorders and diseases.

Key words: obesity, metabolic diseases, genetics, socio-economic factors, gene-environment interactions

Researcher: Karri Silventoinen

Parental and childhood health may have significant consequences for educational and labour market outcomes. Acute health shocks and chronic conditions are known to affect employment careers among middle-aged adults, but less is known about the social consequences of illness for children and youth.

We use large, internationally exceptional register-based data on families with annual repeated measurements on parents and children over several decades to quantify the social consequences of parental and childhood health problems and to clarify the causal mechanisms through which they may affect educational and employment trajectories in youth.

Health-related marginalization in youth may have long-term consequences in terms of unemployment and labour market exclusion. These present a major strain on both the individual and the social protection system. By identifying key mechanisms of health related selection the results will inform policy interventions aiming at reducing such harm.

Key words: childhood health, parental health, educational outcomes, employment outcomes, intergenerational transmission

Researchers: Heta Moustgaard, Hanna Remes, Niina Metsä-Simola, Janne Mikkonen and Mikko Aaltonen

Among the many concerns relating to population ageing is the growing number of people living with Alzheimer’s disease and other types of dementia. Progressive dementia is one of the most important causes of disability at older ages and people with dementia commonly need long-term institutional care at the end of life. This project will enhance understanding of the dynamics between socioeconomic, demographic and health-related factors that contribute to dementia risk throughout the life-course and the use of institutional long-term care with dementia.

Keywords: Alzheimer’s disease, dementia, elderly, life course, long-term care, socioeconomic position, nursing home

Researcher: Kaarina Korhonen

Key publications:

Korhonen, K., Einiö, E., Leinonen, T., Tarkiainen, L., & Martikainen, P. (2018). Time-varying effects of socio-demographic and economic factors on the use of institutional long-term care before dementia-related death: A Finnish register-based study. PloS one, 13(6), e0199551.

Information on factors influencing the length of working lives and the distribution of life years between work and retirement is crucial for policy development in ageing societies. We found that both working life expectancy at age 50 and the share of remaining life spent in work have increased across periods following the recession of the early 1990s, and across successive cohorts. The trends were similar across the social classes, but there were large differences in the numbers of years spent in various states: compared with upper non-manual employees, male and female manual workers were expected to spend fewer years in both work and statutory retirement, but more years in other forms of non-employment. The likelihood of retirement through any route at age 63–64 was higher among people who became subject to the new flexible statutory pension age between 63 and 68 than among people who were subject to the old system with a fixed statutory pension age at 65. The reform led to increased retirement at age 63–64 regardless of health status, but the change was more pronounced among people with better health. In absolute terms, however, people with poorer health still retire a little bit earlier. After the reform, high levels of education, social class, and income were associated with a longer time spent in employment either in the form of later retirement or participation in post-retirement employment. Otherwise, economic constraints including high debt, low wealth, and renting one’s home were associated with continued employment both before and after retirement.

Keywords: socioeconomic factors, health, working life expectancy, labour market participation, timing of retirement, post-retirement employment, pension reform

Researcher: Taina Leinonen

Key Publications:

Leinonen T, Laaksonen M, Chandola T, Martikainen P. Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland. Soc Sci Med 2016;158:149–57.

Leinonen T, Martikainen P, Myrskylä M. Working Life and Retirement Expectancies at Age 50 by Social Class: Period and Cohort Trends and Projections for Finland. J Gerontol B Psychol Sci Soc Sci published online 11 November 2015.

The death of a spouse is one of the biggest emotional shocks in life, and it is known to have a major effect on health. This study will expand our previous work on the effects of widowhood by studying short-term hospitalizations before and after the death of a spouse. We will use panel data and methods to examine the risks of being hospitalized due to various diseases and accidents. Our research contributes to the debate on adverse consequences of stressful life events.

Key words: widowhood, bereavement, hospital use

Researcher: Elina Einiö