University of Oulu

Ina Rissanen, Iiro Nerg, Leena Ala-Mursula, Marko Korhonen, Lost individual income due to severe health events: life-course perspective in the Northern Finland Birth Cohort 1966, European Journal of Public Health, Volume 32, Issue 5, October 2022, Pages 723–728,

Lost individual income due to severe health events : life-course perspective in the Northern Finland Birth Cohort 1966

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Author: Rissanen, Ina1,2,3; Nerg, Iiro4; Ala-Mursula, Leena2,3;
Organizations: 1Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
2Center for Life Course Health Research, University of Oulu, Oulu, Finland
3Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
4Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2022-12-19


Background: Severe health events may lead to reduced income among survivors. Importantly, individuals’ risks for both severe health events and for lower income are shaped by early life course. Our aim was to consider early-life factors in determining lost individual income after stroke, heart attack and cancer between ages 18 and 50.

Methods: A population-based Northern Finland Birth Cohort 1966 (N = 12 058) was used. Early-life factors were collected since mid-pregnancy until age 16 years and used to match all persons with stroke, heart attack, or cancer (n = 995) with four controls. Registered annual individual income development 15 years before and after the event was compared between cases and propensity score matched controls using time-to-event mixed models, stratified for sex.

Results: Compared to controls, a new decreasing income trend emerged among women after stroke (logarithmic income per time −0.54; 95% CI −0.88 to −0.20), whereas men getting stroke showed declining earnings already by the time of the event, further declining after stroke (−1.00, −1.37 to −0.63). Getting heart attack was associated with a new declining trend both in women (−0.68; −1.28 to −0.09) and men (−0.69, −1.05 to −0.32). Income declined also among control men (−0.24, −0.34 to −0.14), who had higher income but were less educated than control women.

Conclusions: Stroke and heart attack but not cancer have exogenous deleterious effects on individual economy, independently of early-life factors. The effects accelerate by time. Negative income trend in control men shows that severe health events do not explain all decrease in income.

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Series: European journal of public health
ISSN: 1101-1262
ISSN-E: 1464-360X
ISSN-L: 1101-1262
Volume: 32
Issue: 5
Pages: 723 - 728
DOI: 10.1093/eurpub/ckac110
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
511 Economics
Funding: NFBC1966 received financial support from University of Oulu [65354, 24000692]; Oulu University Hospital [2/97, 8/97, 24301140]; Ministry of Health and Social Affairs [23/251/97, 160/97, 190/97]; National Institute for Health and Welfare [54121]; and European Regional Development Fund [539/2010 A31592]. This work was supported by Finnish Work Environment Fund. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Dataset Reference: Supplementary data are available at EURPUB online.
Copyright information: © The Author(s) 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.