Population Health


Social and Economic Determinants of Hospital Use, Morbidity, and Mortality over the Life Course

Yaoyue Hu, Karen van Hedel, Pekka Martikainen, Mikko Myrskylä; in Collaboration with Govert Bijwaard (Netherlands Interdisciplinary Demographic Institute (NIDI), Netherlands)

Detailed description:

Social and economic characteristics are one of the most well-established sets of determinants of health. Socially disadvantaged groups have lower levels of health than more advantaged groups, which is true across countries, populations, ages, and health outcomes. Many of our analyses rely on a nationally representative 11% random sample of the population permanently residing in Finland between the end of 1987 and 2007. Information from various registers is linked and updated at the end of each year, including labor-market data, hospital discharge records, death records, and social care records. The longitudinal registry data have advantages over panel studies because they have long-term follow-up, annually repeated measures, a very large analytical population, and no attrition.

Older adults are disproportionately heavy users of health-care services because of health vulnerabilities related to the aging process. To improve the provision of hospital care to older adults, it is particularly important to understand how social and economic factors influence older adults’ hospital use. We should also seek to gain new and deeper insights into how social disparities in hospital usage change across later life; i.e., whether social disparities continue to grow, start to diminish, or remain stable with increasing age. Other key questions are whether certain living arrangements, such as living alone, are more closely related to higher levels of hospital use than living with a spouse or partner and how the relationship between living arrangements and hospital use differs with increasing age, net of individual heterogeneity. The total number of days per year spent in hospital (an indicator of hospital use) was obtained for individuals aged 50-89 for the years 1988-2007. We then applied longitudinal data-analysis techniques to answer these questions. We find that socioeconomic differences in days spent in hospital continued to diverge at ages 50-70, but started to converge at ages 70+. Living alone is associated with a higher risk of having at least nine annual total hospital days than living with a partner, but this association attenuated with increasing age and disappeared when we took individual heterogeneity into account.

Among young adults, a rich body of literature (mainly focusing on children and adolescents) has confirmed that socially disadvantaged groups are at higher risk of injury, which is the leading cause of mortality, morbidity, and disability among young individuals, and is largely preventable. But much less is known about social and economic differences in injury morbidity, particularly among young individuals who are in transition to adulthood, and are more likely to adopt health-compromising and risk-taking behaviors. We defined injury morbidity as hospital-treated injures, with information extracted from the hospital-discharge records of young adults aged 17-29 and issued between 1998 and 2008. We find that injury risks are consistently higher among those who have lower education and those who have earlier or later than average transitions in education, employment, and family formation.

Research keywords: Ageing, Mortality and Longevity; Health Care, Public Health, Medicine, and Epidemiology


Hu, Y.; Leinonen, T.; Myrskylä, M.; Martikainen, P.:
Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 1-12 (2018).
Avendano , M.; Moustgaard, H.; Martikainen, P.:
European Journal of Epidemiology 32:1, 77-85 (2017).
Kilpi, F.; Silventoinen, K.; Konttinen, H.; Martikainen, P.:
Social Science and Medicine 177, 100-109 (2017).
Kilpi, F.; Silventoinen, K.; Konttinen, H.; Martikainen, P.:
European Journal of Public Health 26:2, 260-266 (2016).