Abstract
Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.
Highlights
National-level measures of mortality often hide important withincountry differentials
We present median hazard ratio (MHR) for empty, and age-adjusted models, and a model further adjusted for socioeconomic characteristics for each of the ten periods to investigate the extent to which changes in area vari ation were explained by changes in municipality age and socioeconomic structures
Using individual-level data on the total Finnish population spanning nearly 50 years, we explored long-term trends in municipal-level mor tality variation and the contribution of individual compositional factors
Summary
National-level measures of mortality often hide important withincountry differentials. Deindustrialisation constitutes a key feature of social change over the past decades, which has affected areas unevenly leading to growing regional differentiation and changes in the spatial population distribution (Bontje & Musterd, 2012; Martinez-Fernandez & Noya, 2012; Oswalt et al, 2006). We propose that these processes may be associated with the reported trends in within-country mortality variation.
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