The Effect of Regional Occupational Structure on Mortality in a Transition Economy

1. 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

2. Individual versus contextual effects of occupation and regional occupational structure? • Environmental hazards • at working place • Differential income by • occupation • Work related stress, etc. • Environmental hazards • (e.g., pollution) • Health infrastructure • Social interaction effects • (e.g., information about • life styles) • Living conditions Regional factors Individual working conditions Individual effects Contextual effects

3. Regional mortality differentials in Bulgaria

4. Regional mortality differentials in Bulgaria Silistra Vidin Dobritch Razgrad Vraca Ruse Pleven Montana Shumen Targoviste Veliko Tarnovo Varna Lovetch Sofia- okrag Gabrovo 3.5 yrs. difference in male LE at age 35 Sofia Sliven 2.84 yrs. difference in female LE at age 60 2.6 yrs. difference in female LE at age 35 2.03 yrs. difference in male LE at age 60 Pernik Burgas Stara Zagora Plovdiv Jambol Kjustendil Pazardshik Haskovo Blagoevgrad Smoljan Kardshali Lowest male-female difference in LE at age 35 - 5.27 yrs. Highest male-female difference in LE at age 35 - 7.5 yrs. • Male and female life expectancy do not necessarily follow the same regional pattern

5. Data Percentage of linked deaths by regions • 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 Above 88% -- < 90% Above 90% -- < 93% Above 93% -- < 95% Above 95% -- < 99.1% Cross-sectional dataset Analysis of longitudinal patterns of mortality by socioeconomic group is not possible This analysis: 30--80 yrs. old population: 4.8 Mio Men:Women: 2.3 Mio & 44,528 deaths 2.5 Mio & 27,742 deaths

6. Model Individual or aggregated regional characteristics Baseline hazard with constant mortality risks in two-year age intervals Regional indices are calculated as the mean of the observed individual characteristics of the working population, age 20--60 yrs. Piecewise-constant proportional survival model

7. Regional indices: summary statistics

8. Results- Males

9. Results- 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 risk of death (holding individual characteristics constant) Possible explanation: differences in living conditions

10. Results

11. Results

12. Conclusions • 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.)

15. Results- Males