The Effect of Regional Occupational Structure on Mortality in a Transition Economy
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The Effect of Regional Occupational
Structure on Mortality in a
Transition Economy
Individual versus
Spill-Over Effects
Iliana Kohler
Max Planck Institute for Demographic Research, Rostock, Germany
Individual versus contextual effects of Individual versus contextual effects of occupation and regional occupational structure?occupation and regional occupational structure?
Individual effects Contextual effects
• Environmental hazards
at working place
• Differential income by
occupation
• Work related stress, etc.
Individual working conditions
• Environmental hazards
(e.g., pollution)
• Health infrastructure
• Social interaction effects
(e.g., information about
life styles)
• Living conditions
Regional factors
Regional mortality differentials in BulgariaRegional mortality differentials in Bulgaria
Regional mortality differentials in BulgariaRegional mortality differentials in Bulgaria
Sofia
Sofia- okrag
Pernik
Kjustendil
Blagoevgrad
Paz
ard
shik
Smoljan
Plovdiv
Kardshali
Haskovo
Stara ZagoraJambol
SlivenBurgas
VarnaShu
men
Dobritch
Silistra
Raz
grad
Targoviste
RuseVeliko TarnovoGabrovo
Lovetch
PlevenVraca
Mon
tana
Vidin
3.5 yrs. difference in male LE at age 352.6 yrs. difference in female LE at age 352.03 yrs. difference in male LE at age 602.84 yrs. difference in female LE at age 60
• Male and female life expectancy do not necessarily follow the same regional pattern
Lowest male-female difference in LE at age 35 - 5.27 yrs.
Highest male-female difference in LE at age 35 - 7.5 yrs.
• First individual-level dataset that covers socioeconomic and mortality information for the entire Bulgarian population
• Unique dataset for a CEE country
• Similar population-based individual-level datasets exist primarily in Scandinavian countries
Cross-sectional dataset Analysis of longitudinal patternsof mortality by socioeconomicgroup is not possible
DataData
Percentage of linked deaths by regions
Above 88% -- < 90%
Above 90% -- < 93%
Above 93% -- < 95%
Above 95% -- < 99.1%
This analysis:This analysis:
30--80 yrs. old population:4.8 Mio
Men: Women:2.3 Mio & 44,528 deaths 2.5 Mio & 27,742 deaths
ModelModel
) exp( ) ( ) (1 0i
K
iix x h x
Piecewise-constant proportional survival model
Baseline hazard withconstant mortality risks in two-year age intervals
Regional indices are calculated as the mean of the observed individual characteristics of the workingpopulation, age 20--60 yrs.
Individual or aggregatedregional characteristics
Table1: Summary statistics of theaggregated regional indices for occupational structurein Bulgaria, 1993.
Aggregated Regional Index M ean Std. Dev. M in M ax(N=28 regional indeces)
Employed in heavy 0.138 0.054 0.062 0.323industry
Employed in light 0.224 0.031 0.175 0.282industry
Employed in 0.124 0.049 0.018 0.222agriculture
Other branches of employment 0.362 0.048 0.309 0.554(primarily services)
Index of unemployed and 0.152 0.029 0.082 0.216economically unactivepopulation
Regional unemployment 0.010 0.006 0.001 0.021Notes: Each index is calculated as themean of theobserved individualcharacteristics of theworking population, age20{60 years.
retired population aboveage60, thebranch of occupation/employment is determined on
thebasis of theperson's last occupation. In order to get an appropriatedescription of the
current occupational composition, the aggregated regional indices are calculated on the
basis of the individual characteristics of theworking population 20 to 60 years old since
most persons above age 60 are retired. Table 1 summarized the characteristics of these
aggregated indices re°ecting thevariation in theoccupational and employment structure
by region.
9
Regional indices: summary statisticsRegional indices: summary statistics
ResultsResults - Males- MalesEffect of regional occupational structure on the risk of death in
Bulgaria, Males 30--60 yrs
0.1
0.4
0.7
1
1.3
1.6
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Mortality DIfferentials by branch of employment in Bulgaria, Males 30--60 yrs
0.8
1
1.2
1.4
1.6
1.8
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Mortality DIfferentials by branch of employment in Bulgaria, Males 60--80 yrs
0.8
0.9
1
1.1
1.2
1.3
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Effect of regional occupational structure on the risk of death in Bulgaria, Males 60--80 yrs
0.5
1
1.5
2
2.5
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
ResultsResults - Females- Females
Living in a region with high industrialization and higher level of
heavy industry (as measured by the regional occupational
structure) may be associated with lower risklower risk of death
(holding individual characteristics constant)
Possible explanation:
differences in living conditions
Mortality DIfferentials by branch of employment in Bulgaria, Females 30--60 yrs
0.8
1
1.2
1.4
1.6
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Effect of regional occupational structure on the risk of death in Bulgaria, Females 30--60 yrs
0
1
2
3
4
5
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Effect of regional occupational structure on the risk of death in Bulgaria, Females 60--80 yrs
0.2
0.6
1
1.4
1.8
2.2
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
Mortality DIfferentials by branch of employment in Bulgaria, Females 60--80 yrs
0.8
0.9
1
1.1
1.2
1.3
Heavy
Indu
stry
Heavy
indus
try+e
duc
Light
indu
stry
Light
indu
stry
+edu
c
Agricu
lture
Agricu
lture
+edu
c
Unemplo
yed
(no
activ
e)
Unemplo
yed
(no
activ
e)+e
duc
Re
lati
ve r
isk
of
de
ath
ResultsResults
Table 3: E®ects of individual branch of employment and regional index of occupationalstructureonmortality| relativerisksof death obtained fromapiecewise-constant propor-tional hazard estimation of mortality (baselinehazard of mortality is not reported).
E®ect of explanatory variable M ales Females30{60 yrs. 60{80 yrs. 30{60 yrs. 60{80 yrs.
E®ects of individual branch of employmentEmployed in 1 1 1 1servicesectorEmployed in 1.08 1.05 1.02 1.05heavy industry (0.032)* (0.015)** (0.038) (0.043)
Employed in 1.04 1.03 1.10 1.06light industry (0.027) (0.020) (0.042)+ (0.027)+
Employed in 0.98 0.89 0.95 0.97agriculture (0.038) (0.034)* (0.047) (0.047)
Unemployed or 1.32 1.10 1.13 1.13economically inactive (0.042)** (0.025)** (0.063)+ (0.029)**
Individual index 0.59 0.90 0.76 1.03of living conditions (0.026)** (0.024)** (0.053)** (0.034)
E®ects of regional indices of occupational structureRegional index 0.33 0.55 0.25 0.53of heavy industry (0.129)* (0.098)** (0.095)** (0.205)
Regional index 0.45 0.81 0.14 0.4of light industry (0.267) (0.291) (0.071)** (0.229)
Regional index 0.12 0.95 0.04 0.81of agriculture (0.078)* (0.298) (0.023)** (0.460)
Regional index of 0.16 0.43 0.66 0.55unemployment/ economically inactive (0.213) (0.245) (0.941) (0.693)
Regional index 0.77 1.05 0.67 0.98of living conditions (0.262) (0.213) (0.290) (0.375)
Mediumeducation 1.35 1.23 1.10 1.14(0.071)** (0.024)** (0.056) (0.039)**
Low education 1.81 1.40 1.43 1.39(0.094)** (0.036)** (0.066)** (0.036)**
No education 2.69 1.85 2.65 1.92(0.237)** (0.078)** (0.189)** (0.089)**
Notes: Standard errors in parentheses. p-values: + p · 0:05; * p · 0:01; ** p · 0:001.
19
Table 3: E®ects of individual branch of employment and regional index of occupationalstructureonmortality| relativerisksof death obtained fromapiecewise-constant propor-tional hazard estimation of mortality (baselinehazard of mortality is not reported).
E®ect of explanatory variable M ales Females30{60 yrs. 60{80 yrs. 30{60 yrs. 60{80 yrs.
E®ects of individual branch of employmentEmployed in 1 1 1 1servicesectorEmployed in 1.08 1.05 1.02 1.05heavy industry (0.032)* (0.015)** (0.038) (0.043)
Employed in 1.04 1.03 1.10 1.06light industry (0.027) (0.020) (0.042)+ (0.027)+
Employed in 0.98 0.89 0.95 0.97agriculture (0.038) (0.034)* (0.047) (0.047)
Unemployed or 1.32 1.10 1.13 1.13economically inactive (0.042)** (0.025)** (0.063)+ (0.029)**
Individual index 0.59 0.90 0.76 1.03of living conditions (0.026)** (0.024)** (0.053)** (0.034)
E®ects of regional indices of occupational structureRegional index 0.33 0.55 0.25 0.53of heavy industry (0.129)* (0.098)** (0.095)** (0.205)
Regional index 0.45 0.81 0.14 0.4of light industry (0.267) (0.291) (0.071)** (0.229)
Regional index 0.12 0.95 0.04 0.81of agriculture (0.078)* (0.298) (0.023)** (0.460)
Regional index of 0.16 0.43 0.66 0.55unemployment/ economically inactive (0.213) (0.245) (0.941) (0.693)
Regional index 0.77 1.05 0.67 0.98of living conditions (0.262) (0.213) (0.290) (0.375)
Mediumeducation 1.35 1.23 1.10 1.14(0.071)** (0.024)** (0.056) (0.039)**
Low education 1.81 1.40 1.43 1.39(0.094)** (0.036)** (0.066)** (0.036)**
No education 2.69 1.85 2.65 1.92(0.237)** (0.078)** (0.189)** (0.089)**
Notes: Standard errors in parentheses. p-values: + p · 0:05; * p · 0:01; ** p · 0:001.
19
ResultsResults Table 3: E®ects of individual branch of employment and regional index of occupationalstructureonmortality| relativerisksof death obtained fromapiecewise-constant propor-tional hazard estimation of mortality (baselinehazard of mortality is not reported).
E®ect of explanatory variable M ales Females30{60 yrs. 60{80 yrs. 30{60 yrs. 60{80 yrs.
E®ects of individual branch of employmentEmployed in 1 1 1 1servicesectorEmployed in 1.08 1.05 1.02 1.05heavy industry (0.032)* (0.015)** (0.038) (0.043)
Employed in 1.04 1.03 1.10 1.06light industry (0.027) (0.020) (0.042)+ (0.027)+
Employed in 0.98 0.89 0.95 0.97agriculture (0.038) (0.034)* (0.047) (0.047)
Unemployed or 1.32 1.10 1.13 1.13economically inactive (0.042)** (0.025)** (0.063)+ (0.029)**
Individual index 0.59 0.90 0.76 1.03of living conditions (0.026)** (0.024)** (0.053)** (0.034)
E®ects of regional indices of occupational structureRegional index 0.33 0.55 0.25 0.53of heavy industry (0.129)* (0.098)** (0.095)** (0.205)
Regional index 0.45 0.81 0.14 0.4of light industry (0.267) (0.291) (0.071)** (0.229)
Regional index 0.12 0.95 0.04 0.81of agriculture (0.078)* (0.298) (0.023)** (0.460)
Regional index of 0.16 0.43 0.66 0.55unemployment/ economically inactive (0.213) (0.245) (0.941) (0.693)
Regional index 0.77 1.05 0.67 0.98of living conditions (0.262) (0.213) (0.290) (0.375)
Mediumeducation 1.35 1.23 1.10 1.14(0.071)** (0.024)** (0.056) (0.039)**
Low education 1.81 1.40 1.43 1.39(0.094)** (0.036)** (0.066)** (0.036)**
No education 2.69 1.85 2.65 1.92(0.237)** (0.078)** (0.189)** (0.089)**
Notes: Standard errors in parentheses. p-values: + p · 0:05; * p · 0:01; ** p · 0:001.
19
Table 3: E®ects of individual branch of employment and regional index of occupationalstructureonmortality| relativerisksof death obtained fromapiecewise-constant propor-tional hazard estimation of mortality (baselinehazard of mortality is not reported).
E®ect of explanatory variable M ales Females30{60 yrs. 60{80 yrs. 30{60 yrs. 60{80 yrs.
E®ects of individual branch of employmentEmployed in 1 1 1 1servicesectorEmployed in 1.08 1.05 1.02 1.05heavy industry (0.032)* (0.015)** (0.038) (0.043)
Employed in 1.04 1.03 1.10 1.06light industry (0.027) (0.020) (0.042)+ (0.027)+
Employed in 0.98 0.89 0.95 0.97agriculture (0.038) (0.034)* (0.047) (0.047)
Unemployed or 1.32 1.10 1.13 1.13economically inactive (0.042)** (0.025)** (0.063)+ (0.029)**
Individual index 0.59 0.90 0.76 1.03of living conditions (0.026)** (0.024)** (0.053)** (0.034)
E®ects of regional indices of occupational structureRegional index 0.33 0.55 0.25 0.53of heavy industry (0.129)* (0.098)** (0.095)** (0.205)
Regional index 0.45 0.81 0.14 0.4of light industry (0.267) (0.291) (0.071)** (0.229)
Regional index 0.12 0.95 0.04 0.81of agriculture (0.078)* (0.298) (0.023)** (0.460)
Regional index of 0.16 0.43 0.66 0.55unemployment/ economically inactive (0.213) (0.245) (0.941) (0.693)
Regional index 0.77 1.05 0.67 0.98of living conditions (0.262) (0.213) (0.290) (0.375)
Mediumeducation 1.35 1.23 1.10 1.14(0.071)** (0.024)** (0.056) (0.039)**
Low education 1.81 1.40 1.43 1.39(0.094)** (0.036)** (0.066)** (0.036)**
No education 2.69 1.85 2.65 1.92(0.237)** (0.078)** (0.189)** (0.089)**
Notes: Standard errors in parentheses. p-values: + p · 0:05; * p · 0:01; ** p · 0:001.
19
ConclusionsConclusions • The individual effect of occupation on the risk of death is
observed for both men and women
• This individual effect of occupation persist also at older ages
• Men employed in the heavy industry and women employed in the light industry have a higher risk of death
• The individual effect of occupation cannot be fully explained by education and socioeconomic status
• Surprising spill-over effect in regions with heavy industry -- men and women have a lower risk of death
• This contextual effects may reflect additional differences in socioeconomic development and infrastructure (e.g., specialized health care system, health care knowledge, etc.)
ResultsResults - Males- Males
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