European Journal of Public Health, Vol. 33, No.

1, 13–19
ß The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
https://doi.org/10.1093/eurpub/ckac159 Advance Access published on 15 November 2022
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Income differences in partial life expectancy between
ages 35 and 64 from 1988 to 2017: the contribution of
living arrangements
Jade Knop, Pekka Martikainen , Hanna Remes, Lasse Tarkiainen

Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland

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Correspondence: Jade Knop, Population Research Unit, Faculty of Social Sciences, PO Box 21 (Haartmaninkatu 3),
University of Helsinki, 00014 Helsinki, Finland, Tel: þ358 (0) 405361565, e-mail: jade.knop@helsinki.fi

Background: Socioeconomic differences in mortality among the working-age population have increased in several
high-income countries. The aim of this study was to assess whether changes in the living arrangement compos-
ition of income groups have contributed to changing income differences in life expectancy during the past
30 years. Methods: We used Finnish register data covering the total population to calculate partial life expect-
ancies between ages 35 and 64 by income quartile in 1988–2017. The contribution of living arrangements to these
differences was assessed by direct standardization. Decomposition methods were used to determine the extent of
life expectancy differences due to external (accidental, violent and alcohol-related) causes of death. Results: The
life expectancy gap between the highest and lowest income quartile increased until 2003–07, but decreased
thereafter. The contribution of living arrangements to these differences remained mostly stable: 36–39% among
men and 15–23% among women. Those living without children consistently showed the greatest life expectancy
differences by income. External causes of death significantly contributed to income differences in life expectancy.
Conclusions: The living arrangement composition of income groups explained part of the differences in life
expectancy, but not their changes. Our results on the contribution of external causes of death imply that both
the persistent income gradient in mortality as well as the mortality disparities by living arrangements are at least
partially related to similar selection or causal mechanisms.
.........................................................................................................

Introduction
ncreasing socioeconomic differences in mortality among the
Iworking-age population have been documented in several high-
income countries in recent decades.1–4 Inequalities may be particular-
ly stark between income groups,5 since the indicator allows for the
identification of the most economically disadvantaged. Besides eco-
nomic disadvantage, health-related selection, health behaviours and
sociodemographic factors have been suggested to explain income dif-
ferences in mortality. Previous research suggests that part, but not all,
of the income–mortality association may be explained by pre-existing
health status.6–8 Behavioural arguments are supported by findings
indicating a significant contribution of alcohol- and smoking-
related mortality to socioeconomic life expectancy differences, as
well as changes therein.9–11 The contribution of sociodemographic
factors, such as living arrangements and family characteristics, has
been less studied, although these factors seem to account for some
of the observed socioeconomic differences in mortality.3,12,13
Simultaneously, a related but largely separate line of research has
documented increasing mortality differences by marital status, main-
ly stemming from a sharp and unparalleled decline in mortality
among the married in the late 20th century.14,15 These disparities
have been attributed to selection into and out of marriage based on
health status16–19 or other, e.g. socioeconomic, characteristics18 as
well as health-promoting material19–22 and psychosocial resources
shared between spouses, such as social support and control of health
behaviours.19,22–25 Increases in accidental, violent and alcohol-related
causes of death among the non-married suggest that changes in
health-related behaviours may have played a role in growing marital
status differences in mortality in 1976–2000.14 Mortality differences
by marital status have also been found to attenuate after controlling
for socioeconomic status,14,26,27 but their increase over time does not
seem to be explained by changes in socioeconomic factors, such as
education or occupation.14,28 Since marital status alone does not
capture the relationships and resources within families and house-
holds, a more comprehensive classification of living arrangements
has been proposed to examine differences in health and mortal-
ity.26,27 The relevance of household composition is further demon-
strated by findings suggesting that living alone and the presence of a
partner may in fact be stronger independent predictors of mortality
differences than marital status per se,29 and that childlessness and
non-residential parenthood seem to be related to excess mortality
among the working-age population.27,30,31
Research on the joint contribution of socioeconomic status and
living arrangements to mortality differences has been scarce. As
controlling for household characteristics has been found to attenuate
mortality differences by socioeconomic status,3,12,13 and vice
versa,14,26,27 there is reason to believe that similar mechanisms,
such as health-related selection and health behaviours, may induce
inequalities along both axes. Persons with poor health are more likely
to become unemployed,32,33 leading to lower income, and less likely
to marry,16,17 which may be reflected in mortality differences across
income and marital status groups. Also, mortality trends and differ-
ences by income, marital status and living arrangements tend to be
especially pronounced for behaviour-related i.e. accidental, violent
and alcohol- and smoking-related causes of death.9,11,14,27
Furthermore, a causal link between socioeconomic and family char-
acteristics cannot be excluded: a lack of socioeconomic resources
may reduce the chances of union formation,34 while certain family
transitions, such as divorce, may entail a loss of income.35
In recent decades, unmarried cohabitation, single parenting and
living alone have become increasingly common, while the proportion
14 European Journal of Public Health
of married couples and families with children has declined in many
countries.36–38 It is noteworthy that increases have taken place in
living arrangements associated with poorer health and higher mor-
tality, and in some cases, lower socioeconomic status.27,39 Whether
recent changes in living arrangements have implications for socio-
economic mortality differences depends on whether selection into
different living arrangements or the strength of the association be-
tween household characteristics and mortality have changed. If, e.g.
living alone is increasingly concentrated among those with low in-
come, this ‘double burden’ may increase mortality differences by
income. Given the interrelations between living arrangements, socio-
economic status and health, it is important to consider how changes
in living arrangements may be reflected in trends in socioeconomic
mortality differences.
To our knowledge, there are no previous studies examining the
contribution of living arrangements to income differences in life ex-
pectancy in the working-age population. This study had four specific
aims: (i) to quantify changes in income differences in partial life
expectancy between ages 35 and 64 during the past 30 years, (ii) to
assess how the contribution of living arrangements to the differences
between the highest and lowest income group has changed, (iii) to
examine how life expectancy differences by income differ across
living arrangement groups and (iv) to determine to what extent these
differences were attributable to accidental, violent and alcohol-
related causes of death.
Methods
The data used in this study cover all persons aged 35–64 years resid-
ing in Finland between 1988 and 2017. Statistics Finland linked data
from various registers to death records using personal identification
codes. Register linkage was authorized by data protection authorities
in Statistics Finland (permission TK-53-1490-18). The study popu-
lation was followed for mortality in 1988–2017, stratifying person-
years and deaths by sex, 5-year age group, income quartile and living
arrangements measured at the end of the year prior to follow-up.
Person-years and deaths were aggregated for six 5-year periods
(1988–92 through 2013–17). Those reaching the age of 65 years dur-
ing follow-up were censored at the end of the year, and those turning
35 years were included in the data from the next year onwards.
Individuals who emigrated or were institutionalized were censored
at the end of the year. Altogether, the dataset included 63.1 million
person-years and 288 185 deaths.
Information on income was derived from the registers of the
Finnish Tax Administration and the Social Insurance Institution.
We used the annual sum of taxable income of all household mem-
bers, consisting of wages, capital income and taxable income trans-
fers. Household composition was taken into account by dividing the
total household income by the square root of the number of house-
hold members.40 Cut-off points for income quartiles were calculated
within ages 35–64 separately for each year and sex.
Individuals’ living arrangements were determined according to
information on their marital and cohabitation status, family com-
position and household size. Seven groups were formed: married
with/without children, cohabiting with/without children, single par-
ent, living alone and other. Statistics Finland defined cohabiters as
persons who were living in the same dwelling, unmarried, at least
18 years of age, of different sex, not siblings and had an age difference
of no more than 15 years. The group of others covered adults living
with their parents or someone else than their partner or children,
and those whose living arrangements were unknown.
Directly age-standardized mortality rates were calculated using the
total male and female population aged 35–64 years in 1988–92 and
2013–17 as the standard population. Age-specific mortality rates by
5-year age group, sex, income quartile and living arrangements were
used to obtain abridged period life tables with partial life expect-
ancies between ages 35 and 64, and their confidence intervals, for
each income quartile, 5-year period and living arrangement group.
Life expectancy differences between the highest and lowest income
quartile were decomposed by cause of death in each living arrange-
ment group using Arriaga’s method.41,42 Causes of death were clas-
sified as either internal or external using the harmonized cause-of-
death classification of Statistics Finland, based on the International
Classification of Diseases (ICD). The external category encompassed
accidents, violence and suicides, and alcohol-attributable diseases
and poisoning (see table 2 for specific ICD-10 codes). All other
causes of death, as well as unknown causes (0.33%), were included
in the internal category. To assess the contribution of living arrange-
ments to differences in partial life expectancy between the highest
and lowest income quartile, we calculated adjusted mortality rates for
the lowest income quartile. This was done by weighting the age-
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specific mortality rates of the lowest income quartile so that the
living arrangement distribution of each 5-year age group corre-
sponded to that of the highest quartile.
Results
A clear income gradient in mortality was present for men and
women in both the first and last period of follow-up, with particu-
larly high death rates in the lowest income quartile (table 1). High
mortality was also observed among those living alone and in ‘other’
living arrangements. There were notable changes in living arrange-
ment distributions between periods, with the share of married per-
sons living with children decreasing and the proportion of cohabiters
and those living alone increasing.
Partial life expectancy between ages 35 and 64 increased in all
income quartiles during the study period (figure 1). For men, the
increase was largest in the lowest income quartile (1.6 years, vs.
0.9 years in the highest quartile), whereas for women, gains in life
expectancy were similar in all income quartiles (0.4–0.5 years).
Among both sexes, the gap between the highest and lowest income
quartile widened until 2003–07, and narrowed thereafter. As a result,
the 1-year gap among women remained, while the difference
decreased from 3.0 to 2.3 years among men during the 30-year
follow-up. The contribution of living arrangements to the life expect-
ancy gap was mostly stable throughout the study period. Adjusting
for living arrangements explained 36–39% and 15–23% of the differ-
ence between the top and bottom quartiles among men and women,
respectively (figure 2).
Partial life expectancy increased in all living arrangement groups
in both the highest and lowest income quartile during the study
period (table 2). Income differences in partial life expectancy were
smaller among women than men in each living arrangement group.
Differences between the highest and lowest quartile were greatest
among those living alone and cohabiting without children. The gap
in life expectancy narrowed the most in these living arrangement
groups due to substantial life expectancy increases in the lowest in-
come quartile. By 2013–17, life expectancy differences among men
living alone and cohabiting without children had decreased to 3.2
and 2.1 years, respectively. The corresponding differences among
women were 1.6 and 1.7 years. There were only minor changes
among women in other living arrangement groups. Among men,
increases in life expectancy were greater in the lowest income quar-
tile in all living arrangement groups. Those married with children
showed the smallest income differences in life expectancy among
men in both periods, matched by cohabiting men with children in
2013–17, with respective differences of 0.5 and 0.6 years. Among
women, the gap in life expectancy was smallest among those living
with children, whether married, cohabiting or single parents, at 0.3,
0.4 and 0.4 years, respectively, in 2013–17. Among both sexes, life
expectancy differences between living arrangement groups were
much smaller within the highest income group, further converging
during the study period.
 Income differences in partial life expectancy between ages 35 and 64 from 1988 to 2017 15

Table 1 Age-adjusted mortality rates and distribution of person-years by income and living arrangements among men and women aged 35–
64 in 1988–92 and 2013–17

Men Women

1988–92 2013–17 1988–92 2013–17

Income group Mortality Person- Mortality Person- Mortality Person- Mortality Person-
ratea years ratea years ratea years ratea years
(%) (%) (%) (%)

First quartile (highest) 4.9 25 1.7 25 2.2 25 1.0 25

Second quartile 6.5 25 2.6 25 2.6 25 1.3 25
Third quartile 8.5 25 4.0 25 3.3 25 1.9 25
Fourth quartile (lowest) 14.9 25 10.1 25 5.2 25 4.6 25
Living arrangements
Married with children 5.9 49 2.1 32 2.6 45 1.2 30

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Married without children 7.2 20 3.0 21 3.2 22 1.8 24
Cohabiting with children 8.9 3 2.2 7 3.4 3 1.7 7
Cohabiting without children 11.3 4 3.8 8 5.3 3 2.3 7
Single parent 10.4 2 3.6 2 3.4 9 2.0 10
Alone 16.4 12 8.7 22 4.5 14 3.4 19
Other 18.2 10 10.5 8 8.4 4 7.4 3
All 8.8 100 4.6 100 3.4 100 2.2 100
n (1000s)b 38 4856 26 5296 16 4888 13 5271

a: Age-adjusted mortality rates per 1000 person-years. Standard population: combined population of men and women in 1988–92 and
2013–17.
b: Number of deaths/person-years in thousands.

The contribution of accidental, violent and alcohol-related causes
of death to income differences in life expectancy remained stable
between the first and last period at 47–48% among men and 34%
among women (table 2). However, the contribution of external
causes varied between 21% and 63% across living arrangement
groups, so that these causes tended to contribute more among groups
with larger life expectancy differences by income. Living with chil-
dren was associated with smaller contributions of external causes of
death.
Discussion
Principal findings
Income differences in partial life expectancy between ages 35 and 64
increased from 1988–92 to 2003–07, followed by a decrease from
2003–07 to 2013–17. For men, these developments resulted in a
net decrease in life expectancy differences, while differences
remained largely unchanged for women. Despite changes in the dis-
tribution of living arrangements, their contribution to life expectancy
differences by income remained stable throughout the study period.
Living arrangements explained 36–39% and 15–23% of the life ex-
pectancy gap between the highest and lowest income quartile among
men and women, respectively.
The life expectancy gap between the highest and lowest income
quartile was largest among cohabiters without children and those
living alone, but also narrowed the most in these groups. The gap
was smallest among those living with children, whether married,
cohabiting or single parents, especially among women. By 2013–
17, life expectancy differences between living arrangement groups
had almost disappeared in the highest income quartile. The contri-
bution of external causes of death to income differences in life ex-
pectancy remained stable during the study period at 47–48% among
men and 34% among women. This contribution was greater among
those living without children.
Interpretation of the results
Increasing income differences in life expectancy have been docu-
mented in several high-income countries in recent decades.
Substantial increases have been reported in the USA,1,43 while
more moderate ones have been observed in Canada,44 Denmark43
and Norway.2 These results mostly apply to differences in life ex-
pectancy at all adult ages, although increasing inequalities have been
observed especially among the working-age population.9 In contrast
to these prior findings, we observed a decrease in life expectancy
differences by income from 2003–07 to 2013–17. Existing evidence
suggests that this decline originates from a reduction in alcohol-
related mortality in the lowest income group, particularly among
men.45
Previous studies on socioeconomic mortality differences have
rarely considered the contribution of living arrangements, although
family and household characteristics are known to be socially pat-
terned and to predict mortality outcomes especially in the working-
age population.14,46,47 Our analyses revealed that life expectancy dif-
ferences by income tended to be greatest in living arrangement
groups associated with lower life expectancy, such as living alone
or cohabiting without children. The magnitude of these differences
implied a significant life expectancy disadvantage, a ‘double burden’,
for persons living alone or cohabiting without children in the lowest
income quartile. Despite the largest relative disadvantage, life expect-
ancy differences by income were reduced the most in these living
arrangement groups during the study period. These changes may be
associated with relative improvements in the status of these groups.
Living alone and cohabiting without children increased notably dur-
ing the study period and, with the exception of women living alone,
these groups also experienced the greatest absolute gains in life
expectancy.
We observed substantial attenuations in life expectancy differences
by income after adjusting for living arrangements. These attenua-
tions reflect the fact that persons with lower income tend to live in
less favourable living arrangements more often, e.g. are more likely to
be unmarried and live alone (Supplementary table S1). Our results
suggest that living with children may have mortality-protective
effects among the working-age population, which is in line with
previous findings.27,29,30 Furthermore, this advantage seems to ex-
tend to single parents, especially single mothers, despite previous
studies indicating poorer health among them.40,48,49 Life expectancy
differences by income were smaller among those living with children,
as was the contribution of accidental, violent and alcohol-related
 16
European Journal of Public Health
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Table 2 Partial life expectancy between ages 35 and 64 by living arrangements among men and women in the lowest and highest income quartiles in 1988–92 and 2013–17

1988–92 2013–17

Difference Difference Change in

highest–lowest highest–lowest difference
highest–
Living arrangements Highest (95% CI) Lowest (95% CI) All (95% CI) Years External Highest (95% CI) Lowest (95% CI) All (95% CI) Years External lowest
quartile quartile causes of quartile quartile causes of (years)
death death
(%)a (%)a

Men
Married with children 28.9 (28.8–28.9) 28.1 (28.0–28.2) 28.5 (28.5–28.6) 0.8 34 29.6 (29.6–29.7) 29.2 (29.1–29.2) 29.5 (29.5–29.5) 0.5 33 0.3
Married without children 28.7 (28.6–28.8) 26.4 (26.0–26.8) 27.9 (27.8–28.0) 2.3 50 29.5 (29.4–29.6) 28.0 (27.7–28.3) 29.1 (29.1–29.2) 1.5 61 0.8
Cohabiting with children 28.5 (28.2–28.8) 27.1 (26.7–27.5) 27.7 (27.5–27.9) 1.4 37 29.7 (29.6–29.8) 29.0 (28.9–29.2) 29.4 (29.4–29.5) 0.6 39 0.7
Cohabiting without 28.2 (28.0–28.4) 24.2 (23.8–24.7) 26.9 (26.7–27.0) 4.0 56 29.6 (29.5–29.6) 27.5 (27.2–27.8) 29.0 (28.9–29.1) 2.1 51 1.9
children
Single parent 28.2 (27.6–28.5) 26.6 (26.2–27.0) 27.3 (27.1–27.5) 1.6 59 29.6 (29.0–29.9) 28.4 (28.2–28.6) 29.0 (28.9–29.1) 1.2 41 0.5
Alone 28.0 (27.8–28.1) 23.2 (23.0–23.4) 25.4 (25.3–25.5) 4.7 53 29.3 (29.2–29.3) 26.1 (26.0–26.2) 27.6 (27.5–27.6) 3.2 52 1.6
Other 27.0 (26.8–27.3) 23.6 (23.4–23.7) 25.0 (24.9–25.1) 3.5 48 29.0 (28.9–29.2) 26.2 (26.1–26.4) 27.4 (27.3–27.4) 2.8 39 0.7
All 28.6 (28.6–28.7) 25.7 (25.6–25.8) 27.6 (27.6–27.6) 3.0 47 29.5 (29.5–29.6) 27.3 (27.2–27.3) 28.8 (28.8–28.8) 2.3 48 0.7
Women
Married with children 29.4 (29.4–29.4) 29.2 (29.1–29.3) 29.3 (29.3–29.3) 0.2 9 29.8 (29.7–29.8) 29.4 (29.4–29.5) 29.7 (29.6–29.7) 0.3 21 0.1
Married without children 29.3 (29.2–29.4) 28.1 (27.8–28.4) 28.9 (28.9–29.0) 1.2 42 29.6 (29.6–29.7) 28.6 (28.4–28.8) 29.4 (29.4–29.5) 1.0 63 0.2
Cohabiting with children 29.4 (29.1–29.6) 28.7 (28.3–29.0) 29.0 (28.9–29.1) 0.7 49 29.8 (29.7–29.8) 29.4 (29.2–29.5) 29.6 (29.6–29.7) 0.4 32 0.3
Cohabiting without 29.2 (29.0–29.3) 25.8 (25.3–26.3) 28.2 (28.1–28.4) 3.4 60 29.7 (29.6–29.7) 28.0 (27.7–28.3) 29.3 (29.3–29.4) 1.7 42 1.7
children
Single parent 29.3 (29.0–29.4) 28.9 (28.8–29.0) 29.0 (29.0–29.1) 0.4 26 29.8 (29.6–29.9) 29.4 (29.3–29.4) 29.5 (29.5–29.5) 0.4 38 0.0
Alone 29.4 (29.3–29.5) 27.2 (27.0–27.4) 28.6 (28.5–28.6) 2.2 44 29.7 (29.6–29.8) 28.1 (27.9–28.2) 28.9 (28.9–29.0) 1.6 43 0.6
Other 28.8 (28.5–29.1) 26.1 (25.9–26.4) 27.4 (27.2–27.5) 2.6 25 29.4 (29.2–29.6) 26.6 (26.4–26.9) 28.0 (27.9–28.1) 2.8 19 0.1
All 29.4 (29.3–29.4) 28.4 (28.3–28.4) 29.0 (29.0–29.0) 1.0 34 29.7 (29.7–29.7) 28.7 (28.7–28.8) 29.4 (29.4–29.4) 1.0 34 0.0

The 95% confidence intervals were calculated using Chiang’s I method. For some of the highest quartile groups with no deaths within 5-year age group, the variance of the conditional probability
of death was calculated assuming one death in the age group. These 95% CIs are in italics.
a: ICD-10 codes F10, G312, G4051, G621, G721, I426, K292, K70, K860, K8600, O354, P043, X45, V01–X44, X46–X59, X85–Y89, X60–X84 and Y870.
 Income differences in partial life expectancy between ages 35 and 64 from 1988 to 2017 17

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Figure 1 Partial life expectancy between ages 35 and 64 by income group among men and women in 1988–2017

Figure 2 Adjusted* and unadjusted partial life expectancy between ages 35 and 64 among men and women in the highest and lowest
income quartiles in 1988–2017

causes of death to these disparities. These findings suggest that par-
enthood may be particularly protective among those with low in-
come. Life expectancy differences by income, as well as the
contribution of living arrangements to these differences, were greater
among men than women. Men in the lowest income quartile are
more likely than their higher-income or female counterparts to live
in unfavourable arrangements with respect to mortality, as living
without a partner is more common among those with lower income,
and child custody mainly remains a female responsibility. In 2013–
17, 42% of men and 33% of women in the lowest income quartile
were living alone, whereas 24% of women and only 4% of men in the
lowest income quartile were living in single parent households
(Supplementary table S1).
The notion that similar causal or selection mechanisms may
underlie mortality differences by income and living arrangements
is supported by our results on the contribution of accidental, violent
and alcohol-related causes of death to income differences in life ex-
pectancy. The excess mortality of the lowest income group relative to
the highest one was explained by external causes of death to a greater
extent in living arrangements associated with a lower life expectancy
and greater life expectancy differences by income. However, these
results do not allow us to disentangle causal and selection effects to
determine to which extent mortality differences are due to the influ-
ence of socioeconomic and household characteristics on health
behaviours, or behaviour-related selection into income and living
arrangement groups. In addition, more upstream social determinants
of mortality, such as education and occupational class, as well as
relationship trajectories preceding current living arrangements are
likely underlying factors behind our findings. We encourage future
studies to investigate the contribution of these determinants to in-
come and living arrangement differences in mortality across the life
course.
Methodological considerations
The register data used in the study provide reliable measurement free
of self-report bias, covering the entire Finnish population over three
decades with virtually no loss to follow-up and avoiding problems
related to self-reported income. Individuals with zero income com-
prised only 0.3% of the study population in the first and last 5-year
period, as we measured income at the household level, including
taxable social security benefits. As an indicator of socioeconomic
status, income quantiles allow for keeping the proportions of groups
constant over time and are therefore well suited for the study of
temporal changes in mortality. To test the sensitivity of our results
to the categorization of income, alternative analyses were performed
using income quintiles (Supplementary table S2). The results were
highly consistent with those obtained with income quartiles, with life
18 European Journal of Public Health
expectancy differences between extreme groups increasing 0.0–
0.4 years across living arrangement categories.
Statistics Finland’s classification of cohabitation used in the study
inevitably results in the misclassification of some individuals, since
the definition does not cover couples with a large age difference or of
the same sex, but might classify persons not living in a relationship,
such as flatmates, as cohabiting partners. However, this is unlikely to
considerably affect the results, as the share of persons classified as
cohabiters resembles that obtained from nationally representative
survey data in 2017, although survey estimates were somewhat
higher among women aged 30–39 and men aged 40–49.50
Conclusions
Income differences in partial life expectancy in working age (35–
64 years) increased until 2003–07, but decreased towards 2013–17.
The contribution of living arrangements to differences between the
top and bottom income quartiles was substantial and remained stable
throughout the study period. Differences by income were greater
among those living in households without children, particularly
men living alone, and were largely related to accidental, violent
and alcohol-related causes of death. Our results on the importance
of these causes of death imply that both the persistent income gra-
dient in mortality as well as the mortality disparities by living
arrangements are at least partially related to similar selection or
causal mechanisms.
Supplementary data
Supplementary data are available at EURPUB online.
Funding
This work was supported by grants 308247 and 345219 from the
Academy of Finland and grant 101019329 from the European
Research Council.
Conflicts of interest: None declared.
Data availability
Due to data protection regulations of the national register holders
providing the data, they are not allowed to make the data available to
third parties. Interested researchers have the possibility to obtain
data access by contacting Statistics Finland (https://www.stat.fi/tup/
mikroaineistot/index_en.html).
Key points
• Little is known about whether family and household
characteristics are associated with increasing socioeconomic
mortality differences in the working-age population.
• We used Finnish register data covering all persons aged 35–64
between 1988 and 2017.
• The contribution of living arrangements to income differences
in life expectancy was substantial and mostly stable over the
study period.
• Accidental, violent and alcohol-related causes of death
contributed more to income differences in life expectancy in
living arrangement groups where these differences were more
pronounced, such as persons living without children.
• Our results suggest that similar causal or selection mechanisms,
related to e.g. health behaviours, may underlie mortality
inequalities across both income and living arrangement groups.
References
1 Chetty R, Stepner M, Abraham S, et al. The association between income and life
expectancy in the United States, 2001–2014. JAMA 2016;315:1750–66.
2 Kinge JM, Modalsli JH, Øverland S, et al. Association of household income with life
expectancy and cause-specific mortality in Norway, 2005-2015. JAAMA 2019;321:
1916–25.
3 Tarkiainen L, Martikainen P, Laaksonen M. The changing relationship between income
and mortality in Finland, 1988–2007. J Epidemiol Community Health 2013;67:21–7.
4 Blakely T, Fawcett J, Atkinson J. Decades of Disparity II: Socioeconomic mortality
trends in New Zealand, 1981–1999. Wellington: Ministry of Health, 2005.
5 Hoffmann R, Kröger H, Tarkiainen L, Martikainen P. Mortality by education, oc-
cupational class and income in Finland in the 1990s and 2000s. Longitud Life Course
Stud 2020;11:551–85.
6 Blakely T, Kawachi I, Atkinson J, Fawcett J. Income and mortality: the shape of the
Downloaded from https://academic.oup.com/eurpub/article/33/1/13/6827864 by ISTAT user on 29 February 2024
association and confounding New Zealand Census-Mortality Study, 1981–1999. Int J
Epidemiol 2004;33:874–83.
7 Muennig P. Health selection vs. causation in the income gradient: what can we learn
from graphical trends? J Health Care Poor Underserved 2008;19:574–9.
8 Martikainen P, Valkonen T, Moustgaard H. The effects of individual taxable income,
household taxable income, and household disposable income on mortality in
Finland, 1998-2004. Popul Stud (Camb) 2009;63:147–62.
9 Tarkiainen L, Martikainen P, Laaksonen M, Valkonen T. Trends in life expectancy
by income from 1988 to 2007: decomposition by age and cause of death. J Epidemiol
Community Health 2012;66:573–8.
10 Östergren O, Martikainen P, Tarkiainen L, et al. Contribution of smoking and
alcohol consumption to income differences in life expectancy: evidence using
Danish, Finnish, Norwegian and Swedish register data. J Epidemiol Community
Health 2019;73:334–9.
11 Martikainen P, Mäkelä P, Peltonen R, Myrskylä M. Income differences in life ex-
pectancy: the changing contribution of harmful consumption of alcohol and
smoking. Epidemiology 2014;25:182–90.
12 Östergren O. Growing gaps: the importance of income and family for educational
inequalities in mortality among Swedish men and women 1990–2009. Scand J Public
Health 2015;43:563–70.
13 Manderbacka K, Peltonen R, Martikainen P. Amenable mortality by household
income and living arrangements: a linked register-based study of Finnish men and
women in 2000-2007. J Epidemiol Community Health 2014;68:965–70.
14 Martikainen P, Martelin T, Nihtilä E, et al. Differences in mortality by marital status
in Finland from 1976 to 2000: analyses of changes in marital-status distributions,
socio-demographic and household composition, and cause of death. Popul Stud
(Camb) 2005;59:99–115.
15 Murphy M, Grundy E, Kalogirou S. The increase in marital status differences in
mortality up to the oldest age in seven European countries, 1990–99. Popul Stud
(Camb) 2007;61:287–98.
16 Fu H, Goldman N. Incorporating health into models of marriage choice: demo-
graphic and sociological perspectives. J Marriage Fam 1996;58:740–58.
17 Mastekaasa A. Marriage and psychological well-being: some evidence on selection
into marriage. J Marriage Fam 1992;54:901–11.
18 Cheung YB. Can marital selection explain the differences in health between married
and divorced people? From a longitudinal study of a British birth cohort. Public
Health Nat 1998;112:113–7.
19 Joung I. Marital Status and Health: Descriptive and Explanatory Studies. Rotterdam:
Erasmus University Rotterdam, 1996.
20 Lillard LA, Waite LJ. ’Til death do us part: marital disruption and mortality. Am J
Sociol 1995;100:1131–56.
21 Hahn BA. Marital status and women’s health: the effect of economic marital
acquisitions. J Marriage Fam 1993;55:495–504.
22 Wyke S, Ford G. Competing explanations for associations between marital status
and health. Soc Sci Med 1992;34:523–32.
23 Gove WR. Sex, marital status, and mortality. AJS 1973;79:45–67.
24 Umberson D. Family status and health behaviors: social control as a dimension of
social integration. J Health Soc Behav 1987;28:306–19.
25 Broman CL. Social relationships and health-related behavior. J Behav Med 1993;16:
335–50.
 Income differences in partial life expectancy between ages 35 and 64 from 1988 to 2017
26 Drefahl S. Do the married really live longer? The role of cohabitation and socio-
economic status. J Marriage Fam 2012;74:462–75.
27 Koskinen S, Joutsenniemi K, Martelin T, Martikainen P. Mortality differences
according to living arrangements. Int J Epidemiol 2007;36:1255–64.
28 Kravdal Ø, Grundy E, Keenan K. The increasing mortality advantage of the married:
the role played by education. DemRes 2018;38:471–512.
29 Lund R, Due P, Modvig J, et al. Cohabitation and marital status as predictors of
mortality – an eight year follow-up study. Soc Sci Med 2002;55:673–9.
30 Ringbäck Weitoft G, Burström B, Rosén M. Premature mortality among lone fathers
and childless men. Soc Sci Med 2004;59:1449–59.
31 Kobrin FE, Hendershot GE. Do family ties reduce mortality? Evidence from the
United States, 1966-1968. J Marriage Fam 1977;39:737–45.
32 Böckerman P, Ilmakunnas P. Unemployment and self-assessed health: evidence
from panel data. Health Econ 2009;18:161–79.
33 Butterworth P, Leach L, Pirkis J, Kelaher M. Poor mental health influences risk and
duration of unemployment: a prospective study. Soc Psychiatry Psychiatr Epidemiol
2012;47:1013–21.
34 Jalovaara M. Socio-economic resources and first-union formation in Finland,
cohorts born 1969–81. Popul Stud (Camb) 2012;66:69–85.
19
35 Gadalla TM. Impact of marital dissolution on men’s and women’s incomes: a
longitudinal study. J Divorce Remarriage 2008;50:55–65.
36 Kasearu K, Kutsar D. Patterns behind unmarried cohabitation trends in Europe. Eur
Soc 2011;13:307–25.
37 Sobotka T, Toulemon L. Overview Chapter 4: changing family and partnership
behaviour: common trends and persistent diversity across Europe. DemRes 2008;19:
85–138.
38 Miettinen A, Rotkirch A, Szalma I, et al. Increasing Childlessness in Europe: Time
Trends and Country Differences. Helsinki: Population Research Institute of the
Family Federation of Finland, 2014.
39 Hughes ME, Waite LJ. Health in household context: living arrangements and health
in late middle age. J Health Soc Behav 2002;43:1–21.
38 Miettinen A, Rotkirch A, Szalma I, et al. Increasing Childlessness in Europe: Time
Trends and Country Differences. Helsinki: Population Research Institute of the
Downloaded from https://academic.oup.com/eurpub/article/33/1/13/6827864 by ISTAT user on 29 February 2024
Family Federation of Finland, 2014.
39 Hughes ME, Waite LJ. Health in household context: living arrangements and health
in late middle age. J Health Soc Behav 2002;43:1–21.
Additional references [40–50] are provided in the Supplementary Material.