The rare disease neurofibromatosis 1 as a source of hereditary economic inequality: Evidence from Finland.

PURPOSE: This study investigated whether individuals with neurofibromatosis 1 (NF1) fare worse than individuals without NF1 in terms of economic well-being. NF1 is relatively common in the population and provides an informative case of a rare hereditary disease. METHODS: We examined a subset of 692 individuals with verified NF1 from the Finnish total population-based NF1 cohort and compared that with 7407 control individuals matched for age, sex, and municipality during 1997-2014. Economic well-being was operationalized with annual work earnings and total income, including social income transfers. RESULTS: NF1 significantly worsened economic well-being. Low education, increased morbidity, and reduced labor market participation partly explained the effect of NF1. Yet, NF1 was independently associated with lower income even after adjusting for these factors. Furthermore, NF1 had a larger negative effect on income from work than it had on total income, which indicated that the Finnish social security system partly compensated the labor market losses suffered by individuals with NF1. NF1 had a larger impact on economic inequality for men than for women. CONCLUSION: NF1 contributes to economic inequality. A hereditary disease may convey worse economic well-being over several generations.

A rare disease and education: Neurofibromatosis type 1 decreases educational attainment.

Rare heritable syndromes may affect educational attainment. Here, we study education in neurofibromatosis 1 (NF1) that is associated with multifaceted medical, social and cognitive consequences. Educational attainment in the Finnish population-based cohort of 1408 individuals with verified NF1 was compared with matched controls using Cox proportional hazards model with delayed entry and competing risk for death. Moreover, models accounting for the effects of cancer at age 15-30 years, parental NF1 and developmental disorders were constructed. Overall, the attainment of secondary education was reduced in individuals with NF1 compared to controls (hazard ratio 0.83, 95%CI 0.74-0.92). History of cancer and developmental disorders were major predictors of lack of secondary education. Individuals with NF1 obtained vocational secondary education more often than general upper secondary education. Consequently, NF1 decreased the attainment of Bachelor's and Master's degrees by 46%-49% and 64%-74%, respectively. Surprisingly, the non-NF1 siblings of individuals with NF1 also had lower educational attainment than controls, irrespective of parental NF1. In conclusion, NF1 is associated with reduced educational attainment and tendency for affected individuals to obtain vocational instead of academic education. Individuals living with NF1, especially those with cancer, developmental disorders or familial NF1, need effective student counseling and learning assistance.

Does attention-deficit hyperactivity disorder medication reduce entrepreneurship?

Attention-deficit hyperactivity disorder (ADHD) is a highly inheritable condition with a rather stable prevalence over time and geography, and it is associated with a broad range of negative life outcomes. Increasing knowledge on the condition has led to a growing trend of dampening ADHD symptoms through medication. Although this development has led to many positive outcomes, the broader societal implications are still poorly understood. In particular, person-level studies suggest that ADHD-like behavior may possess some advantages for engaging in entrepreneurship and the initiation of new businesses, which is considered a key activity for economic development. Using recent panel data from 11 countries and one special administrative region (SAR), we investigate if the increasing use of ADHD medication in adults is associated with an unintended outcome of reducing entrepreneurship. We find that a roughly one unit increase in the prevalence of adult ADHD medication is associated with a one unit decrease in limited liability company registrations per working age population. In practical terms, the effect of a one within-country/SAR standard deviation increase of adult ADHD medication prevalence corresponds to a decrease in new business formation of 20% of its mean in the sample.

The contribution of morbidity and unemployment for the reduced labor market participation of individuals with neurofibromatosis 1 in Finland.

Neurofibromatosis 1 (NF1) is a multisystem disorder associated with, for example, a high risk for cancer, a variety of behavioral and cognitive deficits, low educational attainment and decreased income. We now examined the labor market participation of individuals with NF1. We analyzed the numbers of days of work, unemployment, and sickness allowance among 742 Finnish individuals with NF1 aged 20-59 years using nationwide register data from Statistics Finland and the Social Insurance Institution of Finland. The individuals with NF1 were compared with a control cohort of 8716 individuals matched with age, sex, and the area of residence. Individuals with NF1 had a significantly lower number of working days per year than the controls (rate ratio [RR] 0.93, 95% CI 0.91-0.95). Unemployment (RR 1.79, 95% CI 1.58-2.02), and sickness absence (RR 1.44, 95% CI 1.25-1.67) were more frequent in the NF1 than in the control group. The causes of sickness allowances were highly concordant with the previously reported morbidity profile of NF1 including neoplasms, cardiovascular disease, mental and behavioral diseases, and neurological diseases. In conclusion, NF1 significantly interferes with labor market participation via both unemployment and morbidity. Unemployment seems to cause more days of not working than sickness absence.

Moving to become healthier?

This paper examines individuals' health and whether it improves when individuals move from a region with poorer health on average to a region with better health on average. We used data from Finland, which is a country with large regional differences in health behaviours and outcomes. We found no evidence that moving from a less healthy region to a healthier region would have any significant effect on the health of individuals who move compared with the health of other individuals. We also examined the potential heterogeneity in the analysed relationships. We found evidence of a relationship between moving itself and health improvements, but this generally true only for our subsample of individuals who had only average or poorer health before moving.

Alcohol consumption and sickness absence: evidence from microdata.

BACKGROUND: Aggregate time-series evidence has shown that overall per capita alcohol consumption is associated with sickness absence. This study re-examines the relationship between alcohol consumption and sickness absence by using individual-level microdata and methods that yield results which are less likely to be due to spurious correlations. METHODS: Data on sickness absence and alcohol consumption for 18 Finnish regions over the period 1993-2005 was used. Sickness absence was measured as the number of sickness absence days during 1 year. Alcohol consumption was measured as the number of alcohol drinks consumed per week. The individual-level relationship between alcohol consumption and sickness absence was estimated by using Poisson regression models. Unobserved determinants of lifestyle behaviours associated with the region and survey year were controlled for. Personal characteristics as well as the clustering of observations by regions were also taken into account. RESULTS: The estimates show that alcohol consumption is associated with sickness absence. The positive relationship between alcohol consumption and sickness absence is particularly pronounced for low-educated males. CONCLUSIONS: Aggregate time-series evidence for the relationship between alcohol consumption and sickness absence is confirmed by using individual-level microdata. The policy lesson is that it is important to take into account the effects of alcohol consumption on the prevalence of sickness absence (i.e. labour supply on an intensive margin) when one is considering the level of taxation of alcoholic beverages.

Economic inequality and population health: looking beyond aggregate indicators.

This paper studies the sensitivity of various health indicators to income inequality as measured by regional Gini coefficients, using individual microdata from Finland over the period 1993-2005. There is no overall association between income and health at the regional level. We discovered that, among men, there are no significant associations between income inequality and several measures of health status. Among women or among both sexes combined, there are some indications of associations in the predicted direction between income inequality and physical health, disability retirement, sick leave, and consumption of medicines, but none are robust to different model specifications. Only among the population aged less than 30 there is some indication that mental health is associated with inequality. Our findings confirm that income inequality in small populations (not large enough to measure the overall class pyramid of the society) is often immaterial for health outcomes.

The physical strenuousness of work is slightly associated with an upward trend in the BMI.

This paper examines the relationship between the physical strenuousness of work and the BMI in Finland, using individual microdata at 5-year intervals over the period 1972--2002. Data came from the National FINRISK Study which contains self-reported information on the physical strenuousness of a respondent's occupation. Our estimates show that the changes in the physical strenuousness of work explain around 7% at most of the increase in BMI for Finnish males observed over a period of 30 years. The main reason for this appears to be the effect of the physical strenuousness of work on BMI which is rather moderate. According to the point estimates, BMI is 2.4% lower when a male's occupation is physically very demanding and involves lifting and carrying heavy objects compared with a sedentary job (reference group of the estimations), other things being equal. Furthermore, it is very difficult to associate the changes in the occupational structure with the upward trend in BMI for females, and the contribution of the changes in the occupational structure is definitely even smaller for females than it is for males. All in all, we show that the changes in self-reported occupation show a slight association with the changes in the logarithm of the BMI scores.

Alcohol-related mortality, drinking behavior, and business cycles: are slumps really dry seasons?

This paper explores the connection between alcohol-related mortality, drinking behavior, and macroeconomic conditions in Finland using both aggregate and microlevel data from recent decades. The aggregate data reveal that an improvement in economic conditions produces a decrease in alcohol-related mortality. Microlevel data show that alcohol consumption increases during economic expansion while the probability of being a drinker remains unchanged. This demonstrates that alcohol-related mortality and self-reported alcohol consumption may be delinked in the short-run business cycle context. One explanation for this paradox is that most harmful forms of drinking are not captured in survey-based data used to study the effect of macroeconomic conditions on alcohol consumption. Our evidence does not overwhelmingly support the conclusions reported for the United States that temporary economic downturns are good for health.

A note on the impact of hours worked on mortality in OECD countries.

We investigate whether an increase in hours worked per employed person raises the total mortality rate in a sample of 23 OECD countries. We build on earlier research but extend the analysis by introducing the number of hours worked per employed as an additional regressor. Contrary to our expectations, we found that an increase in the number of hours worked actually has significantly negative effect on mortality rate, even controlling for income. Although one explanation may be that fluctuations in hours of work is in fact in this setting more a measure of the capacity use rate of the economy than a measure of how stressful work is for individuals who are working, more research on the topic is needed to find a plausible explanation for the observed phenomenon.

Do established health-related quality-of-life measures adequately capture the impact of chronic conditions on subjective well-being?

OBJECTIVES: The paper explores how two well-established, utility-based health-related quality-of-life (HRQoL) measures (EQ-5D and 15D) capture the negative effects of various chronic conditions on subjective well-being (SWB). This is important, as both SWB and health utility can be important aims of health policy and instruments in resource allocation. METHODS: A general population survey representing the Finnish population aged 30 years and over covering 25 self-reported somatic conditions and four psychiatric disorders diagnosed by interviews. RESULTS: Both EQ-5D and 15D fail to capture the effects of some chronic conditions on SWB, but the conditions differ between the instruments. Even after controlling for both EQ-5D and 15D simultaneously, common psychiatric disorders decrease SWB by 0.4 points on a scale 1-10. CONCLUSIONS: Using health utility as a basis for resource allocation is likely to underfund the treatment of psychiatric disorders, in comparison to their effect on the SWB of the population. Different HRQoL instruments yield somewhat different results for different conditions.

The relationship between physical work and the height premium: finnish evidence.

This paper examines the role of physical strength in the determination of the height wage premium by using the "Health 2000 in Finland" data that contain both self-reported information on the physical strenuousness of work, and information on muscle mass from medical examinations. The results suggest that there are generally no distinct differences in the height premium between four different work strain categories. We also find that muscle mass is positively associated with wages per se. The premium is both statistically and economically more significant for men than for women. In terms of occupational sorting, we observe that the shortest men do physically very demanding work and the tallest do sedentary work, even after controlling for the influences of age and education.

Obesity and labour market success in Finland: the difference between having a high BMI and being fat.

This paper examines the relationship between obesity and labour market success in Finland, using various indicators of individual body composition along with body mass index (BMI). Weight, height, fat mass and waist circumference are measured by health professionals. We find that only waist circumference has a negative association with wages for women, whereas no obesity measure is significant in the linear wage models for men. However, all measures of obesity are negatively associated with women's employment probability and fat mass is negatively associated with men's employment probability. We also find that the use of categories for waist circumference and fat mass has a substantial influence on the results. For example, the category for high fat mass is associated with roughly 5.5% lower wages for men. All in all, the results indicate that in the absence of measures of body composition, there is a risk that labour market penalties associated with obesity are measured with bias.

The association of alcohol dependency with employment probability: evidence from the population survey 'Health 2000 in Finland'.

In this paper, we investigate to what extent alcohol-dependent individuals fare worse in the Finnish labour market, using data from a large Finnish health survey. We used the DSM-IV criteria for alcohol dependence assessed by a composite international diagnostic interview (CIDI). We find that there are substantial disadvantages for alcohol-dependent men and women in the labour market, in the sense that they have lower employment probabilities. Treating alcohol dependence as an exogenous variable, we find that alcohol dependence is associated with decrease in the probability of full-time or part-time work of around 14 percentage points for men and 11 percentage points for women. However, accounting for endogeneity increases the negative effect to some 50 percentage points for men and to some 40 percentage points for women.

Does a slump really make you thinner? Finnish micro-level evidence 1978-2002.

This paper explores the relationship between height-adjusted weight and economic conditions in Finland, using individual microdata for the period 1978-2002. If anything, the results reveal that an improvement in regional economic conditions measured by the employment rate produces a decrease in BMI, other things being equal. The Finnish evidence presented does not support the conclusions reported for the USA, according to which temporary economic slowdowns are good for health. In contrast, at least BMI seems to increase during slumps.

Abstaining from alcohol and labour market underperformance--have we forgotten the 'dry' alcoholics?

AIMS: To investigate whether abstainers fare worse than non-abstainers on the labour market because a subset of the abstainers are ex-drinkers with alcohol problems. METHODS: In the cross-sectional population survey 'health 2000 in Finland' (n = 10 000) carried out in 2000, alcohol dependency was measured using the DSM-IV diagnostic criteria for alcohol dependence. The CIDI (composite international diagnostic interview) was applied to ascertain lifetime DSM-IV diagnoses for substance abuse diagnoses, including alcohol dependence. Individuals were considered to be employed if they were working part-time or full-time. RESULTS: Male abstainers have on average 9.5 percentage points lower employment probability than non-abstainers. However, abstainers who have never drunk alcohol do not have lower employment probability than non-abstainers. Abstainers who are diagnosed as alcohol dependent have 27 percentage points lower employment probability than non-abstainers. CONCLUSION: The underperformance of abstainers in a labour market sense is almost entirely due to the fact that some abstainers are ex-drinkers who in our study are identified as alcohol-dependent. Otherwise abstaining does not decrease employment probability.