Differences in life expectancy between areas are significantly larger in men than in women. On the average, the differences have decreased among men but increased slightly among women. The most important causes of death behind the area differences are cardiovascular diseases, alcohol-related causes, accidents and violence.

Background

According to several indicators, the health status among Finns appears to have improved during the past couple of decades (e.g. Koskinen et al. 2012). Meanwhile, differences in health and mortality between population sub-groups (Valkonen et al. 2007; Mäki 2010) and areas (Blomgren et al. 2011) have stayed the same or even increased. Earlier research has shown that area-level variation in mortality and life expectancy are considerably large in both Helsinki and the Helsinki Metropolitan Area (Valkonen and Kauppinen 2001). In the areas where life expectancy was highest to begin with, it has also increased the most, both in absolute and relative terms (Valkonen et al. 2008).However, there is no information on developments in Helsinki after 2005.

Socioeconomic segregation of city areas, as well as the possible concentration of deprivation, have been a prominent topic of research and political debate both in Finland and abroad in recent years. These questions have also been debated in Helsinki, and research has shown that differences between areas have in fact increased. Socioeconomic and ethnic differentiation of areas is relatively well-established development in the Helsinki Metropolitan Area, and it has even strengthened in recent years. To date, however, there are no areas in a vicious circle of socioeconomic deterioration (Vilkama et al. 2014).

There is no recent research on socioeconomic differentiation possibly being reflected in changes of mortality and life expectancy. This article will present the most up-to-date available information on the development of life expectancy in Helsinki and its areas. Life expectancy is a widely used, straightforward and easily understandable measure of mortality. It summarises mortality in different age groups into one single figure, which is unaffected by changes in the age structure over time or by different age structures in different population groups. In addition, the analysis is expanded by discussing healthy life expectancy in each of Helsinki's major district. This method divides life expectancy into years that a person can expect to live in “full health” on one hand and in less than full health on the other on the basis of a selected indicator of health or ill-health.

Data and methods

The analyses in this article were performed using tabulated register-based multivariate data obtained from Statistics Finland (TK–52 – 197–14 and TK–52 – 140–15). These data include yearly information on population and deaths classified by age and sex for major districts and basic districts.The life expectancy was calculated using the mortality and life table. The area-level variation and change in life expectancy was examined further by calculating the mean deviation of life expectancy from the city-level average in Helsinki. Weighted by the population of the areas, the figures will show whether area-level differences in life expectancy have increased or decreased. The change in life expectancy between two time periods was also examined by taking into account the change in mortality from different causes of death as well as the effect of this on the growth of life expectancy. The analysis was conducted by applying the decomposition method. Mortality for different causes of death was age-standardised by using the overall age structure of Helsinki as the standard population. The healthy life expectancy was calculated using the so-called Sullivan method (Sullivan 1971). In the method, the distribution of the variable describing health or ill-health in different age groups is used for dividing overall life expectancy into healthy and non-healthy years. The variable chosen for the analyses in this article was the share of residents receiving disability pension. Disability pension requires a medical diagnosis of significant disability, which makes it a suitable indicator for describing the share of residents suffering from illness. In addition to the overall life expectancy in Helsinki, some of the tables also show the life expectancy of the dwelling population. This is because the district-based calculations only include the dwelling population, whilst excluding permanently institutionalised persons.

The data employed in the analyses of this article is slightly different to what has been used in previous studies. The information on the number of deaths, for instance, has been available for all ages. This enables the results to be shown as life expectancy at birth. On the other hand, the present data includes slightly fewer variables describing individuals than earlier research. To make the results of this article uniform and comparable over time, they will be presented for a period that has already been covered partly by earlier research.

Results

Differences in life expectancy between areas are considerable in Helsinki

In 2011–2014, life expectancy at birth in Helsinki was 77.5 years for males and 83.3 for females (Table 1). Life expectancy has typically been slightly lower in Helsinki than elsewhere in Finland. During this most recent period, the difference was 0.2 for males and 0.4 for females. However, differences between the eight major districts of Helsinki are large: up to 5.3 years for males and up to 3.0 for females. Life expectancy was highest in the Southern and Northern major districts, and for women also in the Western major district. It was lowest in the Central major district. Although the confidence intervals are rather wide, the lower male life expectancy in the Central major district was statistically significant compared to the rest of the major districts, and the higher life expectancy in the Southern and Northern major districts differed from the figures of most other major districts.

The higher female life expectancy in the Southern major district was statistically significantly different compared to all other parts of Helsinki except the Northern major district.

Figure 1 shows some examples of life expectancy in the basic districts in 2009–2014. The basic districts are a rather heterogeneous group in terms of their population size. To prevent statistical uncertainty from affecting the results, the largest basic districts were selected from within each major district. Also included were such basic districts where the level of mortality deviates considerably from the average for Helsinki. The differences in life expectancy between the basic districts are naturally higher than in the case of the major districts, which are larger geographical areas. The difference between the basic district with the highest and lowest life expectancy was 10.5 years for males and 6.5 years for females. One highly significant result was that in two of the basic districts examined, Vironniemi and Tuomarinkylä, male life expectancy exceeded 80 years. Moreover, in the district of Vironniemi the difference between male and female life expectancy was not statistically significant.

Life expectancy can also be examined by dividing it into expectancy for healthy and non-healthy years. The quantity of these depends very much on the indicator of illness or disability chosen for the purpose. The validity of the indicator must also be considered. The analyses in this article used the share of residents receiving disability pension as an indicator. This will only measure differences among working-age people. Consequently, in life expectancy at birth, the non-healthy years form a rather small share. Nevertheless, the indicator is very valid and well suited to making area-level comparisons. Figure 2 describes the extent to which the different areas deviated from the average for all of Helsinki during 2010–2014, regarding both life expectancy and healthy life expectancy. In the Southern major district, the life expectancy of men was two years higher than the average, but the healthy life expectancy was three years higher. Conversely, in the Central major district, the life expectancy of men was approximately three years lower than the average, but the expectancy of healthy years was nearly four years lower. The difference in life expectancy between the best and weakest major district was thus approximately five years, but the difference in healthy life expectancy was as high as seven years. In women, the results were very similar, but the difference between the extremes was smaller: slightly under three years for life expectancy, but four for healthy life years. Thus, especially in the Central but also the Eastern major district, not only is life expectancy lower than the average of all of Helsinki, but the population in these districts also suffers more ill-health during this shorter life.

Changes in differences in life expectancy between areas

Overall, life expectancy of men and women in Helsinki has increased by 4.5 years and 3.0 years respectively between the periods under examination, 1996–2000 and 2011–2014 (Figure 3). Between 2006–2010 and 2011–2014, life expectancy in Helsinki increased by 1.7 years in men but only 0.6 years in women. If the major districts are examined in more detail, male life expectancy has increased in each of them, although the increase in the Southern major district is very slight. Female life expectancy, on the other hand, has only increased in the Southern, Western and Central major districts. Elsewhere in Helsinki it has remained the same or even decreased.

However, the results should be interpreted with caution, as the confidence intervals were rather wide, especially for the most recent period covering only four years. The difference in life expectancy between the major districts with the highest and lowest life expectancy has not increased significantly over time. For men, the difference would seem to be slightly lower than during the first decade of the 21st century, and for women, slightly higher. The area-level variation and change in life expectancy can be examined further by calculating the mean deviation of life expectancy. It shows the deviation in years of life expectancy from the overall average in Helsinki. The mean deviation takes into account the population size of the districts. It was calculated as a weighted average from the absolute values of the district-specific deviations. The larger the mean deviation, the bigger the area-level difference in life expectancy. For men, the differences in life expectancy between districts are large, but they have not increased further in recent years (Figure 4). For women, the area-level differences in life expectancy seem to be growing slightly.

Causes of death underlying the differences

Examination by cause of death helps us to understand the background to the changes in life expectancy and the differences across districts. This is because different causes of death have different effects on the changes, and the importance of different causes of death for the overall mortality varies slightly between areas. This article examines how the aforementioned importance of different causes of death has developed between 2001–2005 and 2011–2013. This period is especially interesting as there were major changes to the maximum allowed amounts of imported alcohol in the spring of 2004, and the price of alcoholic products also decreased considerably due to cuts in alcohol taxation. On the other hand, the increase in life expectancy during this period has been sufficiently large to enable an analysis of the change.

Between 2001–2005 and 2011–2013, life expectancy in Helsinki increased by 2.7 years in men and 1.8 years in women. Figure 5 shows the effect that the different causes of death have had on this growth. For most causes of death, the mortality rates have decreased. For example, the fall in mortality from cardiovascular diseases has caused an increase of approximately one year in life expectancy. Furthermore, mortality from accidents and violence has decreased, especially among men. On the other hand, mortality from alcohol-related diseases and accidental poisoning by alcohol (referred to below as alcohol-related causes) has increased so much that the effect on the growth of life expectancy has been negative. Mortality from dementia and Alzheimer’s disease has also risen. These figures take into account the impact of the changing age structure, but the increased prevalence of memory disorders as a cause of death is also partially explained by improved diagnostics (Statistics Finland 2012).

Area-level analysis of causes of death is challenging, as there are so few deaths in each major district that the role of contingency complicates the interpretation of the results. In this article, the major districts were combined in the manner used earlier by Valkonen et al. (2008): Southern with Northern, Western with South-eastern and Eastern with North-eastern. Not only the areas but also the time periods under examination were grouped. The analysis focused on the most recent six years for which district-level data by cause of death is available (2006–2012). The mortality figures by area and cause of death will be shown in comparison to the average mortality in Helsinki (= 100) for the corresponding cause of death.

In both men and women, mortality from all the causes examined differed clearly according to district (Figure 6). For nearly all causes of death, mortality was lowest in the Southern and Northern major districts and highest by far in the Central major district. When overall mortality for diseases is examined, for instance, it can be seen that mortality was lower in the Southern and Northern major districts and higher in the Central major district compared to both the average for Helsinki and the other areas. The differences are statistically significant.

In addition, among men mortality for cardiovascular diseases, alcohol-related causes, accidents and violence was lower in the Southern and Northern major districts than in Helsinki on average. In these districts, the mortality among women for all the examined causes except dementia and Alzheimer’s disease was lower than the average. Among men, mortality for cancers, and especially lung cancer, was also lower than the average, but the difference was not statistically significant.

In the Central major district, mortality among both sexes for cardiovascular diseases, alcohol-related causes, accidents and violence was higher than the average for Helsinki. In addition, mortality among men from cancers and among women from dementia and Alzheimer’s disease was higher than the average for Helsinki.

In the Western and South-eastern major districts, mortality appeared to be lower for most causes of death than the average for Helsinki, but the difference was not statistically significant in the main. An exception was the lower mortality among women for dementia and Alzheimer’s disease. Correspondingly, mortality among both men and women in the Eastern and North-eastern major districts was slightly higher than the average for Helsinki. The difference was statistically significant only for cardiovascular diseases in men and alcohol-related diseases in women.

Concluding remarks

During the time period examined in this article, life expectancy in Helsinki has increased, although the growth in women’s life expectancy has slowed during the past few years. The growth is a result of decrease in mortality in Helsinki from most causes of death, such as cardiovascular diseases, accidents, violence and cancer. On the other hand, mortality for alcohol-related causes as well as dementia and Alzheimer’s disease has increased so much that this has lowered average life expectancy.

Area-level differences in life expectancy continue to be very wide. The differences are significantly larger in men than in women, but have not increased further during the period examined in this article. For women, the area-level differences even seem to have increased slightly. However, this would appear to have been caused by the fact that life expectancy has increased faster in the Southern major district than elsewhere in Helsinki. For men, the Central major district continues to stand out for its higher-than-average mortality. Compared to the other parts of Helsinki, mortality for nearly all the examined causes of death was higher there. Due to their prevalence, cardiovascular diseases are the most significant cause of death in producing differences. However, relative differences are also large in alcohol-related causes as well as accidents and violence.

That mortality has stayed significantly higher in the Central major district than elsewhere is somewhat surprising. The social composition of the district has changed considerably, and many of the other indicators relevant for mortality do not stand out at all from the average for Helsinki. For instance, the share of residents with only primary-level education has decreased faster than elsewhere in Helsinki from the first half of the previous decade onwards. Today, the share is the second lowest of any major district. Correspondingly, the share of residents with tertiary-level education has increased and now exceeds the average for all of Helsinki. (City of Helsinki Urban Facts 2013; Statistics Finland 2012.). On the other hand, it has to be noted that in the Central major district, the share of single-person households is significantly higher than the average, and the share of families with children significantly lower (Helsingin seudun aluesarjat 2015). This may have a connection to the higher mortality in the area.

Development towards polarisation may be part of the background to the high relative level of mortality in the major district. Although the area is developing in a positive direction according to many measures, there is a population sub-group in which mortality has remained high for some reason. For instance, the residents with only primary education, whose number is shrinking, may become even more vulnerable in a society that is changing in many aspects. There are also more residential services for homeless people and alcoholics in the Central major district than elsewhere in Helsinki. As mortality in these population sub-groups is higher than in the rest of the population, this may be part of the explanation for the lower life expectancy.  It should be noted that these groups are currently counted as part of the dwelling population, due to the general shift in recent years from institutional to assisted living. However, according to the scenario calculation made for this article, the higher mortality of this population group will only contribute at most a 0.6-year decrease to the average life expectancy in the Central major district. It will therefore only explain a small share of the lower life expectancy. Moreover, it must be kept in mind that corresponding assisted-living services are also available elsewhere in Helsinki. The life expectancy in all major districts would increase slightly if their users were excluded from the calculations, largely preserving the existing difference between the areas. On the other hand, geographical polarisation may occur within a single major district, for example when basic districts develop in opposite directions. Answering these questions will be important in the future.

One rather surprising result emerged from the analysis of life expectancy in certain selected basic districts. In Vironniemi, there was no statistically significant difference between male and female life expectancy. Both in that district and in Tuomarinkylä, male life expectancy exceeded 80 years. The result shows that the average life expectancy among men, too, can reach very high levels. Significantly, this finding concerns an entire population sub-group and not only exceptionally long-lived individuals. The basic districts are not examined here by cause of death, as the low number of cases entails an element of contingency. However, the analysis suggests that mortality from cardiovascular diseases in particular, but also alcohol-related diseases, is significantly lower in Tuomarinkylä and Vironniemi than elsewhere in Helsinki.

The results on the area-level differences in life expectancy generate important practical information from the perspectives of service demand and service production. From the viewpoint of research, it would be interesting to examine the extent to which the differences are due to the so-called compositional effect – the assumption that people living in different areas have, for instance, different social characteristics – and to what extent the social characteristics of the districts are linked to differences in life expectancy. These questions have been examined earlier in Helsinki, but the most recent results are from 2005. Further research using this approach is therefore necessary.

Netta Mäki, PhD, is Researcher at City of Helsinki Urban Facts.

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