Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 communitydwelling Finnish persons aged 70-99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.

ObjectivesThe objective of the study was to examine diagnosis-specific sickness absences of different lengths as predictors of disability retirement in different occupational classes.DesignRegister-based prospective cohort study up to 8 years of follow-up.ParticipantsA 70% random sample of the non-retired Finnish population aged 25–62 at the end of 2006 was included (n=1 727 644) and linked to data on sickness absences in 2005 and data on disability retirement in 2007–2014.Main outcome measuresCox proportional hazards regression was utilised to analyse the association of sickness absence with the risk of all-cause disability retirement during an 8-year follow-up.ResultsThe risk of disability retirement increased with increasing lengths of sickness absence in all occupational classes. A long sickness absence was a particularly strong predictor of disability retirement in upper non-manual employees as among those with over 180 sickness absence days the HR was 9.19 (95% CI 7.40 to 11.40), but in manual employees the HR was 3.51 (95% CI 3.23 to 3.81) in men. Among women, the corresponding HRs were 7.26 (95% CI 6.16 to 8.57) and 3.94 (95% CI 3.60 to 4.30), respectively. Adjusting for the diagnosis of sickness absence partly attenuated the association between the length of sickness absence and the risk of disability retirement in all employed groups.ConclusionsA long sickness absence is a strong predictor of disability retirement in all occupational classes. Preventing the accumulation of sickness absence days and designing more efficient policies for different occupational classes may be crucial to reduce the number of transitions to early retirement due to disability.

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Martikainen, P., Ma¨ki, N., and Blomgren, J., 2004, The effects of area and individual social characteristics on suicide risk: A multilevel study of relative contribution and effect modification, European Journal of Population, 20: 323-350.Abstract. The aim of this study is to analyse how area characteristics affect suicide mortality and to assess whether the effects of individual socio-economic characteristics vary in socioeconomically different areas. Data come from the 1990 census records of 15-99-year-old Finns linked to death records in 1991-2001 including 13,589 suicides. Area characteristics were obtained for 85 functional regions. We show that hypotheses of interaction between individual and area socio-economic status for suicide mortality are not supported. However, area socioeconomic characteristics, family cohesion and voting turnout are consistently related to suicide. The effects of median income and income inequality are less consistent. Adjusting for individual level variables partly attenuate these associations. The results indicate that improving the areas people live in may prevent suicide. Martikainen, P., Ma¨ki, N., et Blomgren, J., 2004, Effets des caracte´ristiques sociales re´gionales et individuelles sur le risque de suicide : une e´tude multiniveau de leur contribution relative et de leur prise en compte, Revue Europe´enne de De´mographie, 20: 323-350. Re´sume´. Dans cette e´tude, nous analysons comment les caracte´ristiques locales pe`sent sur la mortalite´par suicide et comment les effets des caracte´ristiques socio-e´conomiques des individus varient en fonction des diffe´rentes re´gions. Pour ce faire, les de´ce`s enregistre´s en Finlande entre 1991 et 2001, dont 13 589 suicides, ont e´te´couple´s aux enregistrements individuels du recensement de 1990, pour les personnes de 15 a`99 ans. Les caracte´ristiques locales concernent 85 re´gions. L'hypothe`se de l'existence d'une interaction entre le statut socio-e´conomique de la re´gion et celui de l'individu n'est pas confirme´e. Cependant, certaines caracte´ristiques socio-e´conomiques de la re´gion, ainsi que la cohe´sion familiale et la European Journal of Population (2004) 20: 323-350 323participation e´lectorale, sont nettement associe´es au suicide. Les effets du revenu me´dian et des ine´galite´s de revenus sont moins nets. Ces relations sont atte´nue´es si l'on controˆle les variables individuelles. Les re´sultats montrent que l'ame´lioration globale de la situation socio-e´conomique des re´gions peut avoir un effet pre´ventif sur le suicide des individus qui y vivent.

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individuallevel register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.

BackgroundMusculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005–2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes.MethodsA 70-per-cent random sample of Finns aged 25–64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005–2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148–694,142) and male (n = 604,715–642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences.ResultsThe prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible.ConclusionsBy far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.

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ObjectivesSickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupational class differences.DesignPopulation-based, repeated cross-sectional study.SettingA 70% random sample of Finns aged between 25 and 63 years in the years 1996–2013.ParticipantsThe study focused on 25- to 63 year-old female (n between 572 246 and 690 925) and male (n between 525 698 and 644 425) upper and lower non-manual and manual workers. Disability and old age pensioners, students, the unemployed, entrepreneurs and farmers were excluded. The analyses covered 2 160 084 persons, that is, 77% of the random sample.For primary and secondary outcome measures, we examined yearly prevalence of over 10 working days long sickness absence by occupational class. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used to assess the magnitude and changes in occupational class differences.ResultsCompared with mid-1990s, sickness absence prevalence was slightly lower in 2013 in all occupational classes except for female lower non-manual workers. Hierarchical occupational class differences in sickness absence were found. Absolute differences (SII) peaked in 2005 in both women (0.12, 95% CI 0.12 to 0.13) and men (0.15, 95% CI 0.14 to 0.15) but reached the previous level in women by 2009 and decreased modestly in men until 2013. Relative differences narrowed over time (p<0.001) but levelled off by 2013.ConclusionsSickness absence prevalence is currently slightly lower in almost all occupational classes than in the mid-1990s, but occupational class differences have remained large. Ill health and poor working conditions especially in the lower occupational classes should be targeted in order to reduce sickness absence and to achieve longer working lives.