title: The effects of regional characteristics on alcohol-related mortality-a register-based multilevel analysis of 1.1 million men.
abstract: The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n = 1.1 million) as the first level and functional regions of Finland (n = 84) as the second level. The analysis covered men aged 25-64. The data are based on the 1990 census records, which were linked to death records in 1991-1996. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. The individual-level covariates included age, education, socioeconomic status, marital status and mother tongue. The area-level variables considered were the proportion of manual workers, unemployment level, median household income, Gini coefficient of income, family cohesion, voting turnout, level of urbanisation and proportion of Swedish-speaking inhabitants. A high proportion of manual workers and of unemployed and low social cohesion (family cohesion and voting turnout) were found to produce adverse effects on alcohol-related mortality, and the independent effects of these variables remained after adjustment for all individual-level and area-level characteristics. The protective effect of high level of urbanisation was revealed after adjustment for other individual- and area-level characteristics. Neither mean income nor income inequality were related to alcohol-related mortality. Adjusting for individual-level variables diminished the average relative deviation of alcohol-related mortality among the functional regions by 41%. The inclusion of area-level characteristics in the model resulted in a total diminution of variation of 79%. The area characteristics considered in this study had a notable effect on alcohol-related mortality, although these effects were smaller than those of the individual-level characteristics. Fuller understanding of the mechanisms underlying the effects of area measures of social structure and cohesion on risky alcohol consumption and alcohol-related mortality is needed.
authors.affiliation: Department of Sociology, University of Helsinki, Finland. jenni.blomgren@helsinki.fi
authors.forename: Jenni
authors.initials: J
authors.lastname: Blomgren
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.forename: Tapani
authors.initials: T
authors.lastname: Valkonen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000437:Alcoholism / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D004522:Educational Status; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors