Academic journal article Demographic Research

Contribution of Smoking-Attributable Mortality to Life Expectancy Differences by Marital Status among Finnish Men and Women, 1971-2010

Academic journal article Demographic Research

Contribution of Smoking-Attributable Mortality to Life Expectancy Differences by Marital Status among Finnish Men and Women, 1971-2010

Article excerpt

1.Introduction

Married individuals enjoy longer lives and better health than people in other marital status groups (Rendall 2011). Health behaviors, which have been shown to contribute to health disparities between married and unmarried groups, are one possible contributor to mortality differences by marital status (Dupre, Beck, and Meadows 2009; Molloy et al. 2009; Joung et al. 1995; Joung et al. 1997; Joutsenniemi et al. 2006). One of these behaviors, smoking, strongly affects mortality (Rogers et al. 2005) and it has also been shown to vary by marital status (Molloy et al. 2009; Nystedt 2006; Leinsalu, Tekkel, and Kunst 2007; Helmert and Shea 1998; Lindström 2010; Jones, Gulbis, and Baker 2010; Oh et al. 2010; Broms et al. 2004; Lee et al. 2005). The divorced are more likely to have smoked at some time than the married (Jones, Gulbis, and Baker 2010; Oh et al. 2010). Furthermore, both married men and women are least likely to be current smokers, whereas divorced men and women are most likely to be current smokers with the never married and the widowed falling in between (Molloy et al. 2009; Nystedt 2006; Helmert and Shea 1998; Lindström 2010). Differences between the married and the other marital status groups have also been found in smoking cessation among men, with married men having the highest rates of smoking cessation (Broms et al. 2004; Nystedt 2006).

However, much less is known about the contribution of smoking to health differentials between marital status groups, and the findings from these studies give partially conflicting results (Lund et al. 2002; Wyke and Ford 1992; Joutsenniemi et al. 2006), possibly resulting from differences in the choice of the health measure or differences in the stage of the smoking epidemic. In a study by Lund et al. (2002), selfreported smoking was not found to explain mortality differences by marital status in the 1990s in Denmark. However, Wyke and Ford (1992) found that about 20% of the differences in self-rated health between the married and the previously married was accounted for by smoking among men and women in the 1980s in Scotland. In Finland, Joutsenniemi et al. (2006) found that up to 33% of the differences in self-rated health was due to smoking, after controlling for education, in 1978-1980 and 2000-2001. Although previous population-based studies have made important contributions, studies based on self-reported smoking data from surveys are subject to problems related to accurately capturing lifetime smoking exposure in different marital states, due to factors such as misclassification of past and present smoking statuses, recall bias, and problems in taking into account different smoking intensities or changes in smoking status during follow-up (Ho and Elo 2013).

The mortality advantage of the married over the unmarried groups has also widened in recent decades in many high income countries, including Finland (Hu and Goldman 1990; Valkonen, Martikainen, and Blomgren 2004; Murphy, Grundy, and Kalogirou 2007; Martikainen et al. 2005; Liu 2009). Meanwhile, smoking behaviors have changed markedly since the turn of the 20th century. In Finland, smoking prevalence peaked among male cohorts born in 1911-1925; in those cohorts over 80% of men have ever smoked regularly (Martelin 1984). Among women, smoking prevalence started to increase from the cohorts born at the beginning of the 20th century and peaked at about 45% among the cohorts born in the 1950s (Helakorpi et al. 2004). Accordingly, smoking has had a large but decreasing impact on longevity among men and a smaller but increasing impact on longevity among women (Martikainen et al. 2013), with parallel findings observed in many other high income countries (Preston, Glei, and Wilmoth 2011). While smoking behaviors have changed markedly during the 20th century, no estimates exist of the changing contribution of smoking to marital status differences in mortality.

This study contributes to the current literature on the impact of smoking on mortality by examining the changing impact of smoking on life expectancy differences between married and unmarried groups in an era of increasing mortality disparities and changing patterns of marriage and divorce (Hu and Goldman 1990; Valkonen, Martikainen, and Blomgren 2004; Murphy, Grundy, and Kalogirou 2007; Martikainen et al. …

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