5.1.1 Studies on mortality (Studies I, III and IV)
Study populations
The analyses in all of the sub-studies on mortality are based on the linkage of census or population-registration data on persons certiied as dead according to a unique personal identiication number. All the analyses comprised all Finns aged 15 and above.
In Study I the data from the 1985, 1990, 1995 and 2000 censuses were linked individually to records from the death register for the years 1987–90, 1991–95, 1996–2000 and 2001–03, respectively. The analysis comprised a total of 33.7 million person-years among men and 36.4 million person-years among women.
Two study periods were deined in Study III: 2001–2003 before and 2004–2005 after the price reduction. Longitudinal register data from the employment statis-tics for 2000 and 2003 were linked individually by means of personal identiication codes to the records from the death register. The men in the study population represented about 10.4 million and the women 11.1 million person-years. The data for Studies I and III were in the form of a cross-tabulation of person-years and numbers of deaths according to the variables of interest.
The focus of the analyses in Study IV was on monthly time-series data on alcohol-relat-ed, cardiovascular disease and all-cause mortality rates for the years 1996–2006.
Alcohol-related mortality
Deaths were classiied according to the Finnish edition (FCD) of the International Classiication of Diseases and Related Health Problems, Ninth Revision (ICD-9) (Study I) and Tenth Revision (ICD-10) (Studies I, III and IV). Alcohol-related deaths were deined as those in which alcohol was referred to as the underlying or one of the contributory causes in the death certiicate.
The total pool of alcohol-related deaths used comprised the following two main categories: 1) the underlying cause of death was an alcohol-attributable disease (see below) or alcohol poisoning, and 2) the underlying cause was not alcohol-related, but a contributory cause was an alcohol-attributable disease or alcohol intoxication (ICD10 code F100). Alcohol-attributable diseases included alcohol
dependence syndrome (ICD10 code F102), other mental and behavioral disorders due to alcohol (F101, F103-109), alcoholic cardiomyopathy (I426), alcoholic liver disease (K70), alcoholic diseases of the pancreas (FCD K860), and a few rarely occurring categories (K292, G312, G4051, G621, G721).
Two mutually exclusive cause-of-death categories were formed for the analysis in Study III: acute and chronic alcohol-related causes. Deaths in the chronic category were those of which the underlying cause was alcoholic or an alcohol-attributable disease was a contributory cause, whereas in the acute category the underlying cause was not alcoholic, but alcohol intoxication was a contributory factor. Deaths of which one contributory cause was intoxication and another was an alcohol-attributable disease were included in the acute-causes category.
Independent variables
The independent variables in Study I included sex, ive-year age groups (15–19,…, 90–94, 95+), and education split into the following categories: basic (10 years or less), intermediate (11–12 years), high (13+ years).
In Study III the independent variables derived from employment statistics were gender, ive-year age-groups (15–19,…, 75–79, 80+) and four indicators of socio-economic position. The four educational categories were based on the highest achieved educational level obtained from the national Register of Completed Education and Degrees: basic education, secondary education, lower tertiary and higher tertiary. Occupational social class was divided into six categories: upper white-collar employees, lower white-collar employees, skilled workers, unskilled workers, the self-employed and other. Unemployed and retired persons were clas-siied according to their previous occupations, and people taking care of house-holds were categorised according to the occupation of the head of the household (Valkonen et al. 1993, 14–16). Income was measured as household disposable income per consumption unit and divided into quintiles, with quintile bounda-ries deined for men and women combined in the year 2000. Income comprised all taxable income received by family members after taxes had been subtracted, including wages, capital income and taxable income transfers. Different weights were used for adults and children in the calculation of household-consumption units: for the irst adult, 1.0; for other adults, 0.7; and for children, 0.5. This cor-responds to the OECD equivalence scale (OECD 1982). The information on differ-ent sources of income came from the registers of the Finnish Tax Administration and the Social Insurance Institution. Economic activity included ive categories:
employed, unemployed for a period of 25 months or more during the previous three years, unemployed for less than 25 months, pensioner, and other.
The monthly data were stratiied by gender and ive-year age-groups (15–19,…
,75–79, 80+) in Study IV.
5.1.2 Hospitalisation (Study V)
Monthly time-series data on hospital utilisation attributable to alcohol-related diagnoses were obtained from the Finnish Hospital Discharge Register, which gathers comprehensive information on individual patients in all Finnish public and private hospitals. The monthly data for the years 1996–2006 were stratiied by gender and ive-year age-groups (15–19,…,75–79, 80+). Diagnoses were classiied according to the Finnish edition (FCD) of the International Statistical Classiica-tion of Diseases and Related Health Problems, Tenth Revision (ICD-10). Causes of hospitalisation related to alcohol were deined as those with a reference to alcohol in the primary diagnosis. There were almost 283,000 such incidences, of which 27 per cent referred to alcohol dependence syndrome (ICD-10 code F102), 20 per cent to other mental and behavioural disorders due to alcohol (ICD-10 codes F101, F103-109), 1.7 per cent to alcohol poisoning (ICD-10 code X45), 10 per cent to alcoholic liver diseases (ICD-10 code K70), 0.2 per cent to alcoholic cardiomyopathy (ICD-10 code I426), nine per cent to alcoholic diseases of the pancreas (ICD-10 code, Finnish Edition K860), 0.9 per cent to alcoholic gastritis (ICD-10 code K292), 28 per cent to alcohol intoxication (ICD-10 code F100), 0.2 per cent to maternal care for (suspected) damage to foetus from alcohol (ICD-10 code O354), and 3.7 per cent to other alcoholic diseases (ICD-10 codes G312, G4051, G621, G721). Men accounted for 81 per cent of all hospitalisations related to alcohol.
5.1.3 Area level interpersonal violence study (Study II)
Study sites and period
The sample for this aggregate-level study comprised 86 small areas (tracts) from the Helsinki Metropolitan area, of which 33 belonged to Helsinki, 27 to Espoo and 26 to Vantaa and a small municipality within Espoo (Kauniainen). The populations ranged from 486 to 36,522, with a mean of 10,981, and the tracts were based on the administrative-area division of the municipalities, which is used for policy purposes (Helsinki Region Statistics Database 2007; Kauniainen Statistics Database 2007).
The study period extended from the beginning of 2002 until the end of 2005. The total period was divided into two sub-periods: (1) before the change in the pricing of alcohol (2002–2003) and (2) after the change (2004–2005). The investigation of two symmetric periods in the analysis and allowed to potential bias due to seasonal variations in interpersonal violence.
Area-level crime and socio-demographic characteristics
Data on crime and socio-demographic characteristics were obtained from admin-istrative databases. The main outcome measure was interpersonal violence, but two less severe indicators of disorderly conduct were also included in the analy-ses. The data on interpersonal violence and disorderly conduct were obtained from three sources at the Helsinki Police Department. The irst covered crimes recorded by the police that were speciied as offences against the Penal Code, and the following outcome measures were included in the analysis: assault and battery including the subgroups assault in private homes and in public places, robbery and extortion, disturbance of the domestic peace and rape. The second source of data comprised emergency call-outs related to domestic violence, disturbing behaviour and vandalism, and emergency responses in total. Approximately 80 per cent of these cases were reported to the police emergency centre by the public. Finally, a particular outcome measure was included: being taken into custody due to alcohol intoxication was recorded as a police task but not as a crime. The data consisted of the number of various acts by tract and month in the years 2002–2005.
Six of the seven socio-demographic characteristics were measures of social dis-advantage: for persons aged 15 years or more they included the proportion of people with a basic education, a mean personal income (€ 1,000), manual-class membership and on the unemployment register (the two latter being characteris-tics of the labour force), the proportion of single-parent families, and the propor-tion of homes that were not owner-occupied. A measure of residential instability (outmigration) was also used. All but one of the area-level socio-demographic characteristics were measured in 2002–2003, and manual-class membership was measured in 2000.