Online Supplementary Material s8

ONLINE SUPPLEMENTARY MATERIAL

Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland

Authors: Mauricio Avendano(*)1,2 , Heta Moustgaard3, Pekka Martikainen3,4,5

Affiliations:

1. Department of Social Science, Health and Medicine, King’s College London, London, UK

2. Department Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA

3. Population Research Unit, Department of Social Research, University of Helsinki, Helsinki,

Finland

4. Centre for Health Equity Studies (CHESS), Stockholms Universitet and Karolinska Institutet,

Sweden

5. The Max Planck Institute for Demographic Research, Germany

Address for correspondence:

Mauricio Avendano, PhD

Department of Social Science, Health and Medicine

East Wing, Strand Campus, King's College, London, Strand

London WC2R 2LS, United Kingdom

Email: [email protected]

Tel. +44 7 421 994 782

Supplementary Table 1. Lagged effect of regional unemployment rates on all-cause mortality, Finland, 1989-1996 & 1997-2007

1997-2007 Females Males Females 95%CI RR 95%CI RR 95%CI

Unemployment rate t-1 ( 0.98 , 1.02 ) 1.00 0.98 1.03 ) ( , 1.02 ) 1.01 ( 0.99 , 1.03 ) Unemployment rate t-2 ( 0.98 , 1.02 ) 1.01 0.99 1.03 ) ( , 1.00 ) 1.00 ( 0.98 , 1.02 ) Unemployment rate t-3 ( 0.99 , 1.03 ) 0.98 0.95 1.01 ) ( , 1.00 ) 0.99 ( 0.98 , 1.01 ) Unemployment rate t-4 ( 0.96 , 1.03 ) 0.99 0.95 1.04 ) ( , 1.01 ) 1.00 ( 0.98 , 1.02 ) Unemployment rate t-5 ( 0.97 , 1.05 ) 0.97 0.89 1.06 ) ( , 1.01 ) 1.00 ( 0.98 , 1.01 )

All models include age, employment status change, region and year fixed effects but estimates are omitted from Table. All covariates are measured simultaneously with regional unemployment rate The category 'out of workforce' refers to individuals that were out of the workforce in either year

Supplementary Table 2. Interaction between educational level and lagged regional unemployment rates and all-cause mortality, Finland, 1989-1996 & 1997-2007

198 199 9- 7- 199 200 6 7 Fe Ma mal les es Males Females 95 RR %CI RR 95%CI RR 95%CI 95%CI Yea r t- 2 Un em plo ym ent rat 1.0 1.0 1.0 0.9 0.9 1.0 0.9 1.0 1.0 e 5 ( 1 , 9 ) 9 ( 2 , 7 ) ( 6 , 3 ) 0 ( 0.93 , 5 ) L ow er tetr iary *un em p. rat 0.9 0.9 0.9 0.9 0.8 1.0 0.9 1.0 1.0 e 4 ( 1 , 7 ) 7 ( 8 , 6 ) ( 7 , 7 ) 0 ( 0.91 , 6 ) S 0.9 ( 0.9 , 1.0 ) 1.0 ( 0.9 , 1.1 ) ( 0.9 , 1.0 ) 1 ( 0.98 , 1.1 ) eco 6 1 1 5 8 3 8 4 2 nda ry* une mp .rat e B asic /un kno wn * une mp .rat 0.9 0.9 1.0 1.0 0.9 1.0 0.9 1.0 1.0 e 6 ( 2 , 0 ) 1 ( 3 , 9 ) ( 8 , 5 ) 1 ( 0.97 , 9 ) Yea r t- 3 Un em plo ym ent rat 1.0 0.9 1.0 0.9 0.9 1.0 0.9 1.0 0.9 e 1 ( 6 , 7 ) 9 ( 3 , 5 ) ( 7 , 4 ) 0 ( 0.86 , 8 ) L ow er tetr iary * une mp .rat 1.0 0.9 1.1 0.9 0.9 1.0 0.9 1.0 1.1 e 2 ( 3 , 0 ) 8 ( 0 , 6 ) ( 6 , 5 ) 1 ( 0.98 , 8 ) S 0.9 ( 0.9 , 1.0 ) 1.0 ( 0.9 , 1.0 ) ( 0.9 , 1.0 ) 1 ( 1.04 , 1.1 ) eco 9 3 6 0 3 7 4 2 7 nda ry* une mp .rat e B asic /un kno wn * une mp . rat 0.9 0.9 1.0 1.0 0.9 1.1 0.9 1.0 1.1 e 8 ( 2 , 5 ) 4 ( 7 , 2 ) ( 5 , 4 ) 1 ( 1.02 , 7 ) Yea r t- 4 Un em plo ym ent rat 0.9 0.9 1.0 0.9 0.8 1.0 0.9 1.0 1.0 e 9 ( 2 , 7 ) 3 ( 3 , 4 ) ( 5 , 3 ) 0 ( 0.90 , 1 ) L 1.0 ( 0.9 , 1.1 ) 1.0 ( 0.8 , 1.2 ) ( 0.9 , 1.0 ) 1 ( 0.95 , 1.1 ) ow 2 0 7 3 5 6 6 3 3 er tetr iary * une mp .rat e S eco nda ry* une mp .rat 1.0 0.9 1.1 1.0 0.9 1.1 0.9 1.0 1.1 e 2 ( 5 , 0 ) 6 ( 6 , 8 ) ( 5 , 4 ) 1 ( 0.98 , 3 ) B asic /un kno wn * une mp .rat 1.0 0.9 1.1 1.0 0.9 1.2 0.9 1.0 1.1 e 3 ( 4 , 2 ) 6 ( 4 , 0 ) ( 7 , 4 ) 1 ( 0.98 , 2 ) Yea r t- 5 Un em plo ym ent rat 0.9 0.8 1.1 1.1 1.0 1.4 0.9 1.0 1.0 e 5 ( 3 , 0 ) 8 ( 0 , 0 ) ( 3 , 5 ) 0 ( 0.91 , 2 ) L 1.0 ( 0.8 , 1.3 ) 0.8 ( 0.7 , 1.0 ) ( 0.9 , 1.0 ) 1 ( 0.95 , 1.1 ) ow 8 5 7 5 0 4 5 6 6 er tetr iary * une mp .rat e S eco nda ry* une mp .rat 1.0 0.8 1.1 0.7 0.6 0.9 0.9 1.0 1.1 e 2 ( 8 , 8 ) 8 ( 5 , 3 ) ( 4 , 6 ) 1 ( 0.98 , 0 ) B asic /un kno wn * une mp . rat 1.0 0.9 1.2 0.8 0.7 1.0 0.9 1.0 1.1 e 6 ( 0 , 5 ) 6 ( 1 , 3 ) ( 5 , 7 ) 1 ( 0.97 , 1 ) Yea r t- 6 Un em plo ym ent rat 0.9 0.7 1.1 0.7 0.5 1.0 0.9 1.0 1.0 e 4 ( 5 , 8 ) 6 ( 8 , 1 ) ( 2 , 3 ) 1 ( 0.95 , 5 ) L 1.1 ( 0.8 , 1.5 ) 1.2 ( 0.8 , 1.7 ) ( 0.9 , 1.0 ) 1 ( 0.91 , 1.0 ) ow 5 6 4 2 7 1 7 7 9 er tetr iary * une mp . rat e S eco nda ry* une mp . rat 1.0 0.7 1.3 1.3 1.0 1.8 0.9 1.0 1.0 e 2 ( 8 , 2 ) 6 ( 3 , 0 ) ( 6 , 8 ) 1 ( 0.95 , 5 ) B asic /un kno wn * une mp . rat 1.0 0.8 1.3 1.2 0.9 1.6 0.9 1.0 1.0 e 9 ( 7 , 6 ) 7 ( 7 , 7 ) ( 7 , 8 ) 0 ( 0.94 , 4 ) All models include age, employment status change, region and year fixed effects but estimates are omitted from Table. All covariates are measured simultaneously with regional unemployment rate. Th e cat eg ory 'ou t of wo rkf orc e' ref ers to ind ivid ual s tha t we re out of the wo rkf orc e in eit her yea r Supplementary Table 3. Regional unemployment rates, employment status change and all-cause mortality (model with regional linear trends), Finland, 1989-1996 & 1997-2007 1989-1996 1997-2007 Males Females Females RR RR 95%CI 95%CI

Une mpl oym 1.01 ent rate 0.99 ( , ) 1.01 ( 1.04 1 ( , 1.03 1.01 ( 0.98 , 1.04 ) Emp loy m. stat us chan ge St able emp loy men t 1.00 1.00 1 1.00 Jo b 1.96 loss 2.14 ( , 2.29 ) 1.56 ( 2 ( , 2.77 1.74 ( 1.54 , 1.96 ) N ewly emp loye d 1.92 ( , 2.04 ) 1.26 ( 1.41 1 ( , 2.07 1.37 ( 1.26 , 1.50 ) L 3.39 ( , 3.65 ) 2.25 ( 2.58 4 ( , 4.72 2.73 ( 2.38 , 3.13 ) ong- ter m une mpl oye d O ut of wor kfor ce 4.87 ( , 5.12 ) 4.56 ( 4.70 6 ( , 6.53 6.57 ( 6.19 , 6.97 )

All models include age, region fixed effects, year fixed effects, and regional linear trends, but estimates are omitted from Table The category 'out of workforce' refers to individuals that were out of the workforce in either year t-1 or t-2

Supplementary Table 4. Regional unemployment rates, employment status change and all-cause mortality (controlling for household income), Finland, 1989-1996 & 1997-2007 1989-1996 1997-2007 Males Males Females RR 95%CI RR 95%CI RR RR

1 . 0 Unemployment rate 0.99 0.98 , 1.01 1.01 ( 1.00 ) 1.00 0 , 1.02 ) ( 0.99 , 2 ) Employm. status change Stable employment 1.00 1.00 1.00 1 . Job loss 8 2.01 1.91 , 2.13 1.45 ( 1.16 ) 2.37 2 , 2.60 ) ( 1.41 , 2 ) 1 . Newly employed 4 1.81 1.69 , 1.94 1.18 ( 1.06 ) 1.80 1 , 1.95 ) ( 1.16 , 0 ) 2 . Long-term unemployed 7 3.06 2.90 , 3.23 2.03 ( 1.77 ) 3.93 3 , 4.20 ) ( 2.08 , 1 ) 4 . Out of workforce 4 3.90 3.80 , 4.00 3.34 ( 3.25 ) 4.83 4 , 4.96 ) ( 4.03 , 6 ) 0 . 8 Log household income 0.91 0.90 , 0.91 0.87 ( 0.85 ) 0.91 0 , 0.93 ) ( 0.84 , 9 )

All models include age, region and year fixed effects but estimates are omitted from Table The category 'out of workforce' refers to individuals that were out of the workforce in either year t-1 or t-2

Supplementary Table 5. Employment to population ratio, employment status change and all-cause mortality, Finland, 1989-1996 & 1997- 2007 1989-1996 1997-2007 Males Females Females RR RR 95%CI 95%CI

Emp loy men t to pop. ratio 1.04 ( , 1.03 ) 1.02 ( 1.05 1 ( , 1.01 1.00 ( 0.98 , 1.02 ) Age 1.05 ( , 1.06 ) 1.06 ( 1.06 1 ( , 1.06 1.06 ( 1.05 , 1.06 ) Emp loy m. stat us chan ge St able emp loy men t 1.00 1.00 1 1.00 Jo b loss 2.11 ( , 1.98 ) 1.51 ( 1.90 2 ( , 2.76 1.70 ( 1.50 , 1.93 ) N ewly emp loye d 1.89 ( , 1.78 ) 1.23 ( 1.38 1 ( , 2.03 1.34 ( 1.22 , 1.47 ) L 3.37 ( , 3.13 ) 2.19 ( 2.53 4 ( , 4.75 2.67 ( 2.32 , 3.06 ) ong- ter m une mpl oye d O ut of wor kfor ce 4.38 ( , 4.19 ) 3.77 ( 3.87 5 ( , 5.68 5.00 ( 4.72 , 5.29 )

All models include age, region and year fixed effects but estimates are omitted from Table The category 'out of workforce' refers to individuals that were out of the workforce in either year t-1 or t-2

Supplementary Table 6. Interaction between educational level and employment to population ratio, employment status change and all- cause mortality, Finland, 1989-1996 & 1997-2007

1997-2007 Females Males Females RR 95%CI RR

0 . 0.9 9 Employment to Population ratio ( , ) ( , 1.04 ) 1.01 ( , ) 9 ( 4 , 1.04 )

Educational level 1.0 Upper tertiary 1.00 0 0 . Lower tertiary 1.5 5 ( , ) ( , 1.73 ) 2.69 ( , ) 1 ( 9 , 3.88 ) 1 . Secondary 3.3 9 ( , ) ( , 3.24 ) 3.73 ( , ) 6 ( 1 , 5.93 ) 9 . Basic or unknown 11.1 15.7 16. 6 28.6 ( , ) ( , 1 ) 1 ( , ) 62 ( 6 , 1 )

0 . Lower tertiary *unemp. rate 1.0 9 ( , ) ( , 1.10 ) 1.00 ( , ) 2 ( 4 , 1.11 ) Secondary*unemp. rate ( , ) ( , 1.10 ) 1.00 ( , ) 1.0 ( 0 , 1.07 ) . 9 1 5 0 . Basic/unknown*unemp. rate 1.0 9 ( , ) ( , 1.11 ) 0.98 ( , ) 1 ( 5 , 1.07 )

All models include age, employment status change, region, year fixed-effects, and interactions of educational level with all variables Supplementary Figure 1. Harmonized unemployment rate (out of total labour force), 1989-2014, Finland

Source: Organization for Economic Cooperation and Development19 Supplementary Figure 2. Unemployment rate (15-74 years) in 10 regions with largest populations from 1989 to 2007 in Finland Supplementary Figure 3. Impact of one-point increase in regional unemployment rate on cause-specific mortality, Finland, 1989-2007

1.2 MEN WOMEN 1.15

1.05 o i t a r

1 e t a R 0.95

All models include age, employment status change, region and year fixed-effects Supplementary Figure 4. Hodrick-Prescott Filter-Detrended regional unemployment rate and cause-specific mortality, Finland, 1989- 2007

1.25 MEN WOMEN 1.2

1.1 o i 1.05 t a r

e t 1 a R 0.95

All models include age, employment status change, region and year fixed-effects Supplementary Figure 5. Hodrick-Prescott Filter-Detrended regional unemployment rate and mortality by education, Finland, men, 1989- 1996

1.4 1.3 1.2 1.1 o i t

e t 0.9 a R 0.8 0.7 0.6 0.5

All causes Alcohol-related Cancer Cardiovascular Suicide Traffic accidents

All models include age, employment status change, region and year fixed-effects, as well as interactions of educational level with all variables