Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000–2015: a register-based study
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 categorized 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).
Keywords: Baltic Countries, Finland, alcoholism, differential mortality, education