Abstract
This study aimed to analyse the effects of different socioeconomic indicators on non-alcohol-associated and alcohol-associated suicide in Finland. The data used comprised the 1990 census records for men who were 25–64-years old linked to the death register for 1991–2001. Poisson regression was used to calculate the adjusted relative mortality rates. There were 6,452 suicides among the study population, and in 42% of them alcohol intoxication was a contributory cause. Education, occupation-based social class and household income were inversely and strongly related to suicide regardless of the link with alcohol. For non-alcohol-associated suicide, the effect of education was largely mediated by social class and income, the effect of social class was partly explained by education and partly mediated by income, and the effect of income was rather small after adjustment for the other two indicators. When alcohol was involved, social class mediated a large part of educational effect, but a strong association also remained. Respectively, education explained a large proportion of the social class differences. Income had a minor effect. Adjustment for employment status explained some of the income differences, but living arrangements had little effect. The findings imply that low social class is associated with increased suicide risk regardless of employment status, and that the roots of socioeconomic differences in alcohol-associated suicide lie in early adulthood when education and health behavioural patterns are set. This casts some doubt on claims that current material factors are the main drivers of socioeconomic differences in suicide.
Résumé
Cette étude analyse les effets de différents indicateurs socio-économiques sur la mortalité par suicide liée à l’alcool et non liée à l’alcool en Finlande. A cette fin, les données du recensement de 1990 pour les hommes âgés de 25 à 64 ans ont été appariées au registre des décès pour la période 1991–2001. La régression de Poisson a été utilisée pour estimer des risques relatifs ajustés. Il y avait 6452 suicides dans la population de l’étude, et l’intoxication alcoolique était une cause associée dans 42% des décès. Le niveau d’instruction, la catégorie de profession et le revenu du ménage étaient inversement et fortement reliés au risque de suicide, que l’alcool soit en cause ou pas. Pour les suicides non liés à l’alcool, l’effet du niveau d’instruction opérait largement par le biais de la catégorie sociale et du revenu, l’effet de la catégorie sociale était expliqué en partie par le niveau d’instruction et en partie par le revenu, et l’effet du revenu était plutôt modeste après ajustement pour les deux autres indicateurs. Pour les suicides liés à l’alcool, le niveau d’instruction opérait en grande partie par le biais de la catégorie sociale, mais une association forte persistait après ajustement. Symétriquement, le niveau d’instruction expliquait une grande partie des différences entre catégories sociales. Enfin, le revenu n’avait qu’un effet mineur. Le statut d’activité expliquait une partie des différences par revenu, mais la structure du ménage n’avait que peu d’effet. Ces résultats impliquent que les catégories au bas de l’échelle sociale ont un risque accru de suicide quel que soit le statut d’activité, et que les racines des différences socio-économiques en matière de mortalité par suicide associée à l’alcool remontent au début de l’âge adulte, lorsque le niveau d’instruction et les comportements liés à la santé sont déterminés. Ceci remet en question l’hypothèse selon laquelle ce sont les conditions matérielles présentes qui sont à l’origine des différences socio-économiques en matière de suicide.
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Acknowledgement
This study was supported by the Academy of Finland, Doctoral Programs in Public Health (DPPH) and the Gyllenberg Foundation.
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Mäki, N.E., Martikainen, P.T. The Effects of Education, Social Class and Income on Non-alcohol- and Alcohol-Associated Suicide Mortality: A Register-based Study of Finnish Men Aged 25–64. Eur J Population 24, 385–404 (2008). https://doi.org/10.1007/s10680-007-9147-1
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DOI: https://doi.org/10.1007/s10680-007-9147-1
Keywords
- Alcohol-associated suicide
- Education
- Employment status
- Income
- Living arrangements
- Non-alcohol-associated suicide
- Social class