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Excess Mortality in Patients with Severe Mental Disorders in 1996-2010 in Finland

Sonja Lumme, Sami Pirkola, Kristiina Manderbacka, Ilmo Keskimäki, C. Mary Schooling
2016 PLoS ONE  
Unselected population-based nationwide studies on the excess mortality of individuals with severe mental disorders are scarce with regard to several important causes of death. Using comprehensive register data, we set out to examine excess mortality and its trends among patients with severe mental disorders compared to the total population. Patients aged 25-74 and hospitalised with severe mental disorders in 1990-2010 in Finland were identified using the national hospital discharge register and
more » ... linked individually to population register data on mortality and demographics. We studied mortality in the period 1996-2010 among patients with psychotic disorders, psychoactive substance use disorders, and mood disorders by several causes of death. In addition to all-cause mortality, we examined mortality amenable to health care interventions, ischaemic heart disease mortality, disease mortality, and alcohol-related mortality. Patients with severe mental disorders had a clearly higher mortality rate than the total population throughout the study period regardless of cause of death, with the exception of alcohol-related mortality among male patients with psychotic disorders without comorbidity with substance use disorders. The all-cause mortality rate ratio of patients with psychotic disorders compared to the total population was 3.48 (95% confidence interval 2.98-4.06) among men and 3.75 (95% CI 3.08-4.55) among women in the period 2008-10. The corresponding rate ratio of patients with psychoactive substance use disorders was 5.33 (95% CI 4.87-5.82) among men and 7.54 (95% CI 6.30-9.03) among women. Overall, the mortality of the total population and patients with severe mental disorders decreased between 1996 and 2010. However, the mortality rate ratio of patients with psychotic disorders and patients with psychoactive substance use disorders compared to the total population increased in general during the study period. Exceptions were alcohol-related mortality among patients with psychoactive substance use disorders and female patients with psychotic disorders, as well as amenable mortality among male patients with psychotic disorders. The mortality rate ratio of persons with mood disorders compared to the total population decreased. The markedly high mortality amenable to health care intervention among patients with severe mental disorders found in our study suggests indirectly that they may receive poorer quality somatic care. The results highlight the challenges in co-ordinating mental and somatic health services.
doi:10.1371/journal.pone.0152223 pmid:27010534 pmcid:PMC4807083 fatcat:3dagkk6j65a2rj7rqaxnom3m7i

Are there socioeconomic differences in outcomes of coronary revascularizations—a register-based cohort study

Kristiina Manderbacka, Martti Arffman, Sonja Lumme, Ilmo Keskimäki
2015 European Journal of Public Health  
Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010. Methods: First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to
more » ... em and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models. Results: Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010. Conclusions: In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
doi:10.1093/eurpub/ckv086 pmid:25958240 fatcat:65biqufpyzdbdazq7cppsa6vdm

Association of Income With the Incidence Rates of First Psychiatric Hospital Admissions in Finland, 1996-2014

Kimmo Suokas, Anna-Maija Koivisto, Christian Hakulinen, Riittakerttu Kaltiala, Reijo Sund, Sonja Lumme, Olli Kampman, Sami Pirkola
2019 JAMA psychiatry  
The association between income and mental health has long been a question of interest. Nationwide register data provide means to examine trends and patterns of these associations. To compare income-specific trends in the incidence rates of first psychiatric hospital admissions and to evaluate whether an income gradient exists in the incidence rates at all levels of household income. This population-based open cohort study used linked registry data from nationwide Finnish Hospital Discharge and
more » ... tatistics Finland population registers to determine annual incidence rates of first psychiatric hospital admissions. All Finnish citizens (N = 6 258 033) living in the country at any time from January 1, 1996, through December 31, 2014, contributed to 96 184 614 person-years at risk of first inpatient treatment for mental disorders. The analyses were conducted from August 1, 2018, through September 30, 2019. Equivalized disposable income, sex, age group, reduction in income decile in the previous 3 years, urbanicity, educational level, and living alone status. Annual percentage changes in the age-standardized incidence rates and incidence rate ratios (IRRs). Altogether, 186 082 first psychiatric inpatient treatment episodes occurred (93 431 [50.2%] men), with overall age-standardized incidence rates per 1000 person-years varying from 1.59 (95% CI, 1.56-1.63) in 2014 to 2.11 (95% CI, 2.07-2.15) in 2008. In the highest income deciles, a continuous mean decrease per year of 3.71% (95% CI, 2.82%-4.59%) in men and 0.91% (95% CI, 0.01%-1.80%) in women occurred throughout the study period, in contrast to the lowest deciles, where the trends first increased (1.31% [95% CI, 0.62%-2.01%] increase in men from 1996 to 2007 and 5.61% [95% CI, 2.36%-8.96%] increase in women from 1996 to 2001). In the adult population, an income gradient was observed at all levels of household income: the lower the income decile, the higher the adjusted IRRs compared with the highest decile. The IRRs in the lowest decile varied from 2.94 (95% CI, 2.78-3.11) to 4.46 (95% CI, 4.17-4.76). In other age groups, the gradient did not persist at the highest income deciles. Diagnosis-specific income gradient was steepest in schizophrenia and related psychotic disorders, with estimated IRRs of the lowest income decile of 5.89 (95% CI, 5.77-6.02). In this cohort study, clear negative income gradient in the incidence rates of first hospital-treated mental disorders was observed in the adult population of Finland. These findings suggest that reduction in the use of inpatient care has not taken place equally between different income groups.
doi:10.1001/jamapsychiatry.2019.3647 pmid:31851325 pmcid:PMC6990744 fatcat:lcv423aazbgpfdpjiq3hla4eoy

The contribution of health policy and care to income differences in life expectancy – a register based cohort study

Kristiina Manderbacka, Riina Peltonen, Sonja Lumme, Ilmo Keskimäki, Lasse Tarkiainen, Pekka Martikainen
2013 BMC Public Health  
Sonja Lumme, I have the following competing interests: none declared.  ... 
doi:10.1186/1471-2458-13-812 pmid:24010957 pmcid:PMC3846484 fatcat:wwvd3wq74bbjnmvsdkskmtiqru

Cumulative social disadvantage and hospitalisations due to ambulatory care-sensitive conditions in Finland in 2011─2013: a register study

Sonja Lumme, Kristiina Manderbacka, Martti Arffman, Sakari Karvonen, Ilmo Keskimaki
2020 BMJ Open  
Twitter Sonja Lumme @LummeSonja 15, 2021 at University of Helsinki. Protected by 2 Lumme S, et al.  ...  Downloaded from Lumme S, et al. BMJ Open 2020;10:e038338. doi:10.1136/bmjopen-2020-038338Open access BMJ Open: first published as 10.1136/bmjopen-2020-038338 on 26 August 2020.  ... 
doi:10.1136/bmjopen-2020-038338 pmid:32847920 fatcat:zrv6yn5uiregnnqq4ki57ginou

Health information exchange in Finland: Usage of different access types and predictors of paper use

Hannele Hyppönen, Sonja Lumme, Jarmo Reponen, Jukka Vänskä, Johanna Kaipio, Tarja Heponiemi, Tinja Lääveri
2019 International Journal of Medical Informatics  
Sonja Lumme acted as the statistician, planning the statistical analyses together with Ms Hyppönen, being responsible of the methods-section, conducting the analyses and co-authoring results.  ... 
doi:10.1016/j.ijmedinf.2018.11.005 fatcat:dxxpsig5jbecpgln3xg2w5gaa4

Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: A nationwide registry study

Marko Elovainio, Sonja Lumme, Martti Arffman, Kristiina Manderbacka, Eero Pukkala, Christian Hakulinen
2021 SSM: Population Health  
., 2019; Lumme, Manderbacka, & Keskimaki, 2017; Vehko, Arffman, Manderbacka, Pukkala, & Keskimaki, 2016) , and they cover the whole population at risk in our study.  ... 
doi:10.1016/j.ssmph.2021.100826 pmid:34189239 pmcid:PMC8219898 fatcat:bzaaxw2prjdmvpc44yzpsfiose

Trends of relative and absolute socioeconomic equity in access to coronary revascularisations in 1995–2010 in Finland: a register study

Sonja Lumme, Kristiina Manderbacka, Ilmo Keskimäki
2017 International Journal for Equity in Health  
We estimated the confidence intervals for the C using the approach developed by Lumme et al.  ... 
doi:10.1186/s12939-017-0536-8 pmid:28222730 pmcid:PMC5320656 fatcat:5sfgxv2i5je7dhilyzznv3vkua

A Monte Carlo method to estimate the confidence intervals for the concentration index using aggregated population register data

Sonja Lumme, Reijo Sund, Alastair H. Leyland, Ilmo Keskimäki
2015 Health Services & Outcomes Research Methodology  
One of these simulation techniques was developed in our recent study (Lumme et al. 2012) in which we made a simple assumption of uncertainty around the dependent variable 2r R 2 (y g /y g y) in Eq.  ... 
doi:10.1007/s10742-015-0137-1 pmid:25983615 pmcid:PMC4426159 fatcat:564on2eefjggtfjo7ouqbjty3u

Trends of socioeconomic equality in mortality amenable to healthcare and health policy in 1992–2013 in Finland: a population-based register study

Sonja Lumme, Kristiina Manderbacka, Sakari Karvonen, Ilmo Keskimäki
2018 BMJ Open  
ObjectiveTo study trends in socioeconomic equality in mortality amenable to healthcare and health policy interventions.DesignA population-based register study.SettingNationwide data on mortality from the Causes of Death statistics for the years 1992–2013.ParticipantsAll deaths of Finnish inhabitants aged 25–74.Outcome measuresYearly age-standardised rates of mortality amenable to healthcare interventions, alcohol-related mortality, ischaemic heart disease mortality and mortality due to all the
more » ... ther causes by income. Concentration index (C) was used to evaluate the magnitude and changes in income group differences.ResultsSignificant socioeconomic inequalities favouring the better-off were observed in each mortality category among younger (25–64) and older (65–74) age groups. Inequality was highest in alcohol-related mortality, C was −0.58 (95% CI −0.62 to −0.54) among younger men in 2008 and −0.62 (−0.72 to −0.53) among younger women in 2013. Socioeconomic inequality increased significantly during the study period except for alcohol-related mortality among older women.ConclusionsThe increase in socioeconomic inequality in mortality amenable to healthcare and health policy interventions between 1992 and 2013 suggests that either the means or the implementation of the health policies have been inadequate.
doi:10.1136/bmjopen-2018-023680 pmid:30567823 pmcid:PMC6303580 fatcat:mjqu4uq4knfwzl6hnfan7z4ahi

Regional trends in avoidable hospitalisations due to complications among population with diabetes in Finland in 1996−2011: a register-based cohort study

Kristiina Manderbacka, Martti Arffman, Sonja Lumme, Markku Lehikoinen, Klas Winell, Ilmo Keskimäki
2016 BMJ Open  
doi:10.1136/bmjopen-2016-011620 pmid:27550651 pmcid:PMC5013371 fatcat:uh3sh5iwjrfmbaga7s5lhdcbxa

Longitudinal biobanks-based study on the joint effects of infections, nutrition and hormones on risk of prostate cancer

Sonja Lumme, Leena Tenkanen, Hilde Langseth, Randi Gislefoss, Matti Hakama, Pär Stattin, Göran Hallmans, Herman Adlercreutz, Pekka Saikku, Ulf-Håkan Stenman, Pentti Tuohimaa, Tapio Luostarinen (+1 others)
2016 Acta Oncologica  
To evaluate the individual and combined effects of enterolactone, vitamin D, free testosterone, Chlamydia trachomatis and HPV-18 on the risk of prostate cancer in a large population-based biochemical material that combined three Nordic serum sample banks. Material and methods A joint cohort of 209 000 healthy men was followed using cancer registry linkages. From this cohort altogether 699 incident cases of prostate cancer were identified. Four controls were selected by incidence density
more » ... and matching for country, age and date of the blood sampling. Complete data for all investigated exposures was available for 483 eligible cases and 1055 eligible controls. Multivariate regression analyses were performed to investigate the solitary and combined effects. Results The solitary effects were small. Significantly increased risk [rate ratio 1.6 (95% CI 1.0-2.5)] was found in those seronegative for C. trachomatis infection. The joint effect in risk levels of enterolactone and vitamin D was antagonistic [observed rate ratio (RR) 1.4 (1.0-2.1), expected RR 2.0 (1.0-4.1)] as well as that of HPV-18 and C. trachomatis [observed RR 1.9 (0.8-4.5), expected RR 9.9 (1.1-87.0)]. Conclusion A large follow-up study combining data from several previously investigated exposures to investigate joint effects found no evidence that exposure to two risk factors would increase the risk of prostate cancer from that expected on basis of exposure to one risk factor. If anything, the results were consistent with antagonistic interactions. ARTICLE HISTORY
doi:10.3109/0284186x.2016.1139178 pmid:26878091 fatcat:2kxofmv6o5bizfos7mudunvvrm

Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996–2013: assessing the development of equity in primary health care through clustering of geographic areas – an observational retrospective study

Markku Satokangas, Sonja Lumme, Martti Arffman, Ilmo Keskimäki
2019 BMC Health Services Research  
Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions
more » ... Cs). ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996-2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories. Three trajectories - and thus separate clusters of health centre areas - emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40-63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1-41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13-16% of health centre areas, in rural northern cluster, had 47-92% higher ACSC rates - but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage. We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC.
doi:10.1186/s12913-019-4449-7 pmid:31484530 pmcid:PMC6727548 fatcat:ielekszcu5bzfhdlgpamjxj244

Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: A longitudinal, nested case-control study in the Nordic countries

Pentti Tuohimaa, Leena Tenkanen, Merja Ahonen, Sonja Lumme, Egil Jellum, G�ran Hallmans, P�r Stattin, Sverre Harvei, Timo Hakulinen, Tapio Luostarinen, Joakim Dillner, Matti Lehtinen (+1 others)
2003 International Journal of Cancer  
Vitamin D inhibits the development and growth of prostate cancer cells. Epidemiologic results on serum vitamin D levels and prostate cancer risk have, however, been inconsistent. We conducted a longitudinal nested case-control study on Nordic men (Norway, Finland and Sweden) using serum banks of 200,000 samples. We studied serum 25(OH)-vitamin D levels of 622 prostate cancer cases and 1,451 matched controls and found that both low (<19 nmol/l) and high (>80 nmol/l) 25(OH)-vitamin D serum
more » ... rations are associated with higher prostate cancer risk. The normal average serum concentration of 25(OH)-vitamin D (40 -60 nmol/l) comprises the lowest risk of prostate cancer. The U-shaped risk of prostate cancer might be due to similar 1,25-dihydroxyvitamin D 3 availability within the prostate: low vitamin D serum concentration apparently leads to a low tissue concentration and to weakened mitotic control of target cells, whereas a high vitamin D level might lead to vitamin D resistance through increased inactivation by enhanced expression of 24-hydroxylase. It is recommended that vitamin D deficiency be supplemented, but too high vitamin D serum level might also enhance cancer development.
doi:10.1002/ijc.11375 pmid:14618623 fatcat:vekpe4sokvajvfmsve5gstuf6a

The socioeconomic determinants of myocardial infarction incidence, pre-hospital mortality and fatality

F Kilpi, H Konttinen, K Silventoinen, P Martikainen
2013 European Journal of Public Health  
LummeS Lumme 1 , I Keskimä ki 1,2 1 National Institute for Health and Welfare, Service System Research Unit, Helsinki, Finland 2 University of Tampere, School of Health Sciences, Tampere, Finland Contact  ...  Department Child Health, TNO, Leiden, The Netherlands 2 Epidemiological Research Unit on Perinatal and Women's and Children's Health, INSERM UMRS 953, Paris, France Contact: Sonja  ... 
doi:10.1093/eurpub/ckt126.354 fatcat:chp5ioovmvcqhjntnsc5vfsaou
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