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Marital status, educational level and household income explain part of the excess mortality of survey non-respondents

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Abstract

Survey respondents and non-respondents differ in their demographic and socio-economic position. Many of the health behaviours are also known to be associated with socio-economic differences. We aimed to investigate how much of the excess mortality of survey non-respondents can be explained by the socio-economic differences between respondents and non-respondents. Questionnaire-based adult health behaviour surveys have been conducted in Finland annually since 1978. Data from the 1978 to 2002 surveys, including non-respondents, were linked with mortality data from the Finnish National Cause of Death statistics and with demographic and socio-economic register data (marital status, education and household income) obtained from Statistics Finland. The mortality follow-up lasted until 2006, in which period there were 12,762 deaths (7,994 in men and 4,768 in women) during the follow-up. Total and cause-specific mortality were higher among non-respondents in both men and women. Adjusting results for marital status, educational level and average household income decreased the excess total and cause-specific mortality of non-respondents in both men and women. Of the total excess mortality of non-respondents, 41% in men and 20% in women can be accounted for demographic and socio-economic factors. A part of the excess mortality among non-respondents can be accounted for their demographic and socio-economic characteristics. Based on these results we can assume that non-respondents tend to have more severe health problems, acute illnesses and unhealthy behaviours, such as smoking and excess alcohol use. These can be reasons for persons not taking part in population surveys.

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References

  1. de Heer WF, Israëls AZ. Response trends in Europe: American statistical association. 1992:92–101.

  2. Jones J. The effects of non-response on statistical inference. J Health Soc Policy. 1996;8(1):49–62.

    Article  CAS  PubMed  Google Scholar 

  3. Tolonen H, Dobson A, Kulathinal S. Effect on trend estimates of the difference between survey respondents and non-respondents: results from 27 populations in the WHO MONICA project. Eur J Epidemiol. 2005;20(11):887–98.

    Article  PubMed  Google Scholar 

  4. Jousilahti P, Salomaa V, Kuulasmaa K, Niemela M, Vartiainen E. Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women. J Epidemiol Community Health. 2005;59(4):310–5.

    Article  PubMed  Google Scholar 

  5. Tolonen H, Helakorpi S, Talala K, Helasoja V, Martelin T, Prattala R. 25-year trends and socio-demographic differences in response rates: Finnish adult health behaviour survey. Eur J Epidemiol. 2006;21(6):409–15.

    Article  PubMed  Google Scholar 

  6. Lundberg I, Damstrom Thakker K, Hallstrom T, Forsell Y. Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the PART study on mental disorders. Soc Psychiatry Psychiatr Epidemiol. 2005;40(6):475–83.

    Article  PubMed  Google Scholar 

  7. Sogaard AJ, Selmer R, Bjertness E, Thelle D. The Oslo health study: the impact of self-selection in a large, population-based survey. Int J Equity Health. 2004;3(1):3.

    Article  PubMed  Google Scholar 

  8. Lahaut VM, Jansen HA, van de Mheen D, Garretsen HF. Non-response bias in a sample survey on alcohol consumption. Alcohol Alcohol. 2002;37(3):256–60.

    PubMed  Google Scholar 

  9. Lahaut VM, Jansen HA, van de Mheen D, Garretsen HF, Verdurmen JE, van Dijk A. Estimating non-response bias in a survey on alcohol consumption: comparison of response waves. Alcohol Alcohol. 2003;38(2):128–34.

    PubMed  Google Scholar 

  10. Pietila AM, Rantakallio P, Laara E. Background factors predicting non-response in a health survey of northern Finnish young men. Scand J Soc Med. 1995;23(2):129–36.

    CAS  PubMed  Google Scholar 

  11. Carlsson GS, Svardsudd K. Comparison of participants and non-participants in a population study of injuries. The study of men born in 1913 and 1923. Scand J Soc Med. 1985;13(1):15–22.

    CAS  PubMed  Google Scholar 

  12. Harald K, Salomaa V, Jousilahti P, Koskinen S, Vartiainen E. Non-participation and mortality in different socioeconomic groups: the FINRISK population surveys in 1972–92. J Epidemiol Community Health. 2007;61(5):449–54.

    Article  PubMed  Google Scholar 

  13. Barchielli A, Balzi D. Nine-year follow-up of a survey on smoking habits in Florence (Italy): higher mortality among non-responders. Int J Epidemiol. 2002;31(5):1038–42.

    Article  PubMed  Google Scholar 

  14. Walker M, Shaper AG, Cook DG. Non-participation and mortality in a prospective study of cardiovascular disease. J Epidemiol Community Health. 1987;41(4):295–9.

    Article  CAS  PubMed  Google Scholar 

  15. Makinen T, Borodulin K, Laatikainen T, Fogelholm M, Prattala R. Twenty-five year socioeconomic trends in leisure-time and commuting physical activity among employed Finns. Scand J Med Sci Sports. 2009;19(2):188–97.

    Google Scholar 

  16. Borodulin K, Laatikainen T, Lahti-Koski M, Jousilahti P, Lakka TA. Association of age and education with different types of leisure-time physical activity among 4437 Finnish adults. J Phys Act Health. 2008;5(2):242–51.

    PubMed  Google Scholar 

  17. Crespo CJ, Ainsworth BE, Keteyian SJ, Heath GW, Smit E. Prevalence of physical inactivity and its relation to social class in US adults: results from the third national health and nutrition examination survey, 1988–1994. Med Sci Sports Exerc. 1999;31(12):1821–7.

    Article  CAS  PubMed  Google Scholar 

  18. Helakorpi S, Martelin T, Torppa J, Vartiainen E, Uutela A, Patja K. Impact of the 1976 tobacco control act in Finland on the proportion of ever daily smokers by socioeconomic status. Prev Med. 2008;46(4):340–5.

    Article  PubMed  Google Scholar 

  19. Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European Union: comparing education and income. Prev Med. 2005;40(6):756–64.

    Article  CAS  PubMed  Google Scholar 

  20. Menvielle G, Kunst AE, Stirbu I, Borrell C, Bopp M, Regidor E, et al. Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations? Int J Cancer. 2007;121(3):649–55.

    Article  CAS  PubMed  Google Scholar 

  21. Marmot M. Inequality, deprivation and alcohol use. Addiction. 1997;92(Suppl. 1):S13–20.

    Article  PubMed  Google Scholar 

  22. Roos E, Talala K, Laaksonen M, Helakorpi S, Rahkonen O, Uutela A, et al. Trends of socioeconomic differences in daily vegetable consumption, 1979–2002. Eur J Clin Nutr. 2008;62(7):823–33.

    Article  CAS  PubMed  Google Scholar 

  23. Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003;32(5):830–7.

    Article  PubMed  Google Scholar 

  24. Mackenbach JP, Cavelaars AE, Kunst AE, Groenhof F. Socioeconomic inequalities in cardiovascular disease mortality; an international study. Eur Heart J. 2000;21(14):1141–51.

    Article  CAS  PubMed  Google Scholar 

  25. Fawcett J, Blakely T, Kunst A. Are mortality differences and trends by education any better or worse in New Zealand? A comparison study with Norway, Denmark and Finland, 1980–1990 s. Eur J Epidemiol. 2005;20(8):683–91.

    Article  PubMed  Google Scholar 

  26. Kunst AE, Groenhof F, Mackenbach JP. Mortality by occupational class among men 30–64 years in 11 European countries. EU working group on socioeconomic inequalities in health. Soc Sci Med. 1998;46(11):1459–76.

    Article  CAS  PubMed  Google Scholar 

  27. Mackenbach JP, Kunst AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in Western Europe. The EU working group on socioeconomic inequalities in Health. Lancet. 1997;349(9066):1655–9.

    Article  CAS  PubMed  Google Scholar 

  28. Hu YR, Goldman N. Mortality differentials by marital status: an international comparison. Demography. 1990;27(2):233–50.

    Article  CAS  PubMed  Google Scholar 

  29. Koskinen S, Joutsenniemi K, Martelin T, Martikainen P. Mortality differences according to living arrangements. Int J Epidemiol. 2007;36(6):1255–64.

    Article  PubMed  Google Scholar 

  30. Martikainen P, Martelin T, Nihtila E, Majamaa K, Koskinen S. Differences in mortality by marital status in Finland from 1976 to 2000: analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death. Popul Stud. 2005;59(1):99–115.

    Article  Google Scholar 

  31. Helakorpi S, Patja K, Prättälä R, Aro AR, Uutela A. Health behaviour and health among Finnish adult population, Sprint 2003. Helsinki: National Public Health Institute; 2003. Report no.: B17/2003.

  32. Cox DR, Oakes D. Analysis of survival data. London; New York: Chapman and Hall; 1984.

    Google Scholar 

  33. Wolf HK, Kuulasmaa K, Tolonen H, Ruokokoski E, for the WHO MONICA Project. Participation rates, quality of sampling frames and sampling fractions in the MONICA surveys. 1998 [updated 1998; cited 2008 26 November]; Available from: http://www.ktl.fi/publications/monica/nonres/nonres.htm.

  34. Kjoller M, Thoning H. Characteristics of non-response in the Danish health interview surveys, 1987–1994. Eur J Pub Health. 2005;15(5):528–35.

    Article  Google Scholar 

  35. Sundquist J, Johansson SE. Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39, 156 people in Sweden. J Epidemiol Community Health. 1997;51(1):35–40.

    Article  CAS  PubMed  Google Scholar 

  36. Elstad JI, Dahl E, Hofoss D. Associations between relative income and mortality in Norway: a register-based study. Eur J Pub Health. 2006;16(6):640–4.

    Article  Google Scholar 

  37. Rehkopf DH, Berkman LF, Coull B, Krieger N. The non-linear risk of mortality by income level in a healthy population: US national health and nutrition examination survey mortality follow-up cohort, 1988–2001. BMC Public Health. 2008;8(1):383.

    Article  PubMed  Google Scholar 

  38. Wyke S, Ford G. Competing explanations for associations between marital status and health. Soc Sci Med. 1992;34(5):523–32.

    Article  CAS  PubMed  Google Scholar 

  39. Schoenborn CA. Marital status, health: United States, 1999–2002. Adv Data. 2004;15(351):1–32.

    Google Scholar 

  40. Simpura J, Paakkanen P, Mustonen H. New beverages, new drinking contexts? Signs of modernization in Finnish drinking habits from 1984 to 1992, compared with trends in the European community. Addiction. 1995;90(5):673–83.

    Article  CAS  PubMed  Google Scholar 

  41. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205–28.

    Article  CAS  PubMed  Google Scholar 

  42. Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004;76(Suppl.):S11–9.

    Article  PubMed  Google Scholar 

  43. Paljarvi T, Makela P, Poikolainen K. Pattern of drinking and fatal injury: a population-based follow-up study of Finnish men. Addiction. 2005;100(12):1851–9.

    Article  PubMed  Google Scholar 

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Tolonen, H., Laatikainen, T., Helakorpi, S. et al. Marital status, educational level and household income explain part of the excess mortality of survey non-respondents. Eur J Epidemiol 25, 69–76 (2010). https://doi.org/10.1007/s10654-009-9389-9

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