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