E4080 Demography and Social determinants of health
Practical 1
1. How would you characterise UNEMPLOYMENT – is it a risk factor or determinant of health?
2. In which part of model would unemployment fit best? Why?
3. How would you study the effect of unemployment on health in the Czech population?
a. What type of study?
b. What population group / sample …?
c. Which health outcome?
d. How would you measure this outcome?
e. How would you measure unemployment?
f. Which confounders you would take into account?
g. What types of bias could affect the findings?
4. For the same question, please outline the design of
a. Ecological study
b. Cohort study
c. Case-control study
d. Cross-sectional study
5. The table show results of a Swedish study of unemployment and health. (Eur J Public Health. 2016 Oct; 26(5):
778–783).
Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality?
Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992-96.
Mortality from all and selected causes was examined in the 6-year period after the recession among those employed
in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on
all hospitalizations 1981-91. Unemployment effects on mortality were estimated with and without adjustment for
prior social characteristics and for prior medical history.
HRs and 95% CI for those exposed to unemployment during the 1992–96 recession compared with those not
exposed. All men in Sweden born 1931–65, employed in 1990 and alive on 31 December 1996 (n = 1 747 167).
Model 1: adjusted for birth year; Model 2: Model 1 + adjustment for social, family and employer characteristics.
Model 3: Model 2 + adjustment for prior health status.
Men: mortality during the 1997–2002 post-recession period
Cause-of-death No of deaths
HR (95% CI)
Model 1
HR (95% CI)
Model 2
HR (95% CI)
Model 3
All causes 45 081 1.46 (1.43–1.49) 1.26 (1.23–1.29) 1.26 (1.23–1.28)
All cancer 15 923 1.21 (1.16–1.25) 1.13 (1.09–1.18) 1.14 (1.09–1.18)
Circulatory 15 639 1.31 (1.26–1.36) 1.11 (1.07–1.15) 1.13 (1.09–1.18)
IHD 9954 1.28 (1.22–1.34) 1.08 (1.03–1.13) 1.11 (1.06–1.17)
Stroke 2393 1.50 (1.37–1.65) 1.29 (1.17–1.42) 1.32 (1.20–1.46)
External 5664 2.05 (1.94–2.17) 1.67 (1.58–1.77) 1.59 (1.50–1.69)
Suicide 2419 1.74 (1.60–1.90) 1.48 (1.36–1.62) 1.43 (1.31–1.56)
Transport 953 1.50 (1.30–1.72) 1.33 (1.15–1.53) 1.30 (1.13–1.50)
Alcohol related 960 3.22 (2.83–3.66) 2.33 (2.04–2.66) 2.16 (1.89–2.47)
Women: mortality during the 1997–2002 post-recession
Cause-of-death
No of
deaths
HR (95% CI)
Model 1
HR (95% CI)
Model 2
HR (95% CI)
Model 3
All causes 26 183 1.12 (1.09–1.16) 1.03 (0.99–1.06) 1.03 (1.00–1.07)
All cancer 15 292 1.05 (1.00–1.10) 1.00 (0.96–1.05) 1.01 (0.96–1.05)
Circulatory 4948 1.01 (0.94–1.10) 0.89 (0.82–0.96) 0.91 (0.84–0.99)
IHD 2287 1.04 (0.93–1.18) 0.90 (0.80–1.02) 0.94 (0.83–1.06)
Stroke 1432 1.05 (0.91–1.22) 0.93 (0.80–1.08) 0.94 (0.81–1.10)
External 1912 1.47 (1.33–1.64) 1.24 (1.11–1.39) 1.17 (1.05–1.31)
Suicide 914 1.39 (1.19–1.62) 1.16 (0.99–1.36) 1.08 (0.92–1.27)
Transport 260 0.94 (0.69–1.30) 0.90 (0.65–1.24) 0.89 (0.64–1.23)
Alcohol related 314 2.32 (1.80–3.20) 1.97 (1.53–2.53) 1.91 (1.48–2.46)
a. Describe and interpret the results.
b. What are the differences in results between modesl modely 1, 2 and 3? Why?
6. Have a look at the paper “Decoding the effect of demographic factors on environmental health based on citylevel
PM2.5 pollution in China”. Without reading the results, what effect you would expect the three selected
demographic factors would have on premature deaths associated with exposure to air pollution?
IF THERE IS TIME
7. Read the article “Money for nothing” (Guardian 12.1.2018). What do you think about this study?
a. Design?
b. Size?
c. Likelihood to show beneficial effects on health?
d. Other ideas?