International comparisons are also valuable for studies eval

International comparisons are also valuable for studies evaluating the population-level number of deaths attributable to a behavioral risk factor because these studies often rely on estimates of death risks from the behavioral factor under investigation (Preston & Stokes, 2011; Rostron, 2011). In such studies, death risks are not always available for the country that is the focus of the investigation. It is not uncommon for studies to apply a set of risks from another country to estimate population-level attributable deaths in the country of interest (Gallus et al., 2011; Martelin, Mäkelä, & Valkonen, 2004; Neubauer et al., 2006; Preston & Stokes, 2011; Rodu & Cole, 2004). International comparisons of the risks can aid in assessing whether risks estimated from one dataset or country may be generalizable to other contexts. In this order ceterizine study, we provide a specific comparison of the United States with Finland. Our comparison of the two countries is guided by theoretical and practical concerns. While both countries’ GDP is higher than average for OECD nations, the United States is also characterized by higher levels of poverty and income inequality compared to Finland (OECD, 2016a, 2016b, 2016c). The countries also differ in their healthcare delivery systems and in their behavioral histories, which we review below. These contextual differences provide for an informative comparison. From a practical standpoint, both countries possess a long running series of nationally representative health surveys that contain information on socio-demographic and behavioral risk factors and that are linked prospectively to death records. These surveys and linkages date back to the 1970s in each country. Furthermore, surveys in each country contain information about body weight histories, which as we elaborate below, are useful in addressing key biases arising in the estimation of death risks from obesity. Body weight histories have been rarely collected in nationally representative surveys. All surveys also have information on past and current smoking behavior and socio-demographic characteristics of respondents.
Data and methods
Results Descriptive characteristics in Tables 1 and 2 were discussed in the Introduction. Briefly, obesity levels in the two countries were similar in the 1970s and then diverged over time with U.S. men and women becoming more obese than their Finnish counterparts by the 2000s. American women were more likely to be current or former smokers than Finnish women in all periods, while men in the two groups shared a similar smoking profile. Table 3 shows the coefficients for smoking and obesity and their time trend. We begin with results for current and former smoking. The coefficients in Table 3 are in units of deaths per 1000 person-years. Cigarette smoking is significantly (p<.05) riskier for American women compared to Finnish women (Model 1: β=10.25 vs. 6.55). However, in both populations the risk is rising, by an annual increase of 0.30 deaths per 1000 person-years for American women and 0.22 deaths per 1000 person-years for Finnish women. The level of annual increase was not significantly different across the two countries. The risks associated with former smoking were not statistically different among women in the two countries (β=3.77 (USA) and 2.40 (Finland)). However, Model 2 indicates that the risks associated with former smoking has been increasing over time only among Finnish women, by 0.16 deaths per 1000 person-years per year. Table A1shows estimates of death risks from smoking in analyses stratified by obese status. Consistent with findings shown inTable 3, American women appear to suffer higher risks from cigarette smoking compared to Finnish women regardless of obesity status. Similarly, the risks among both sets of women appear to be increasing over time regardless of obesity status. Findings for men also suggest that stratification by obese status does not result in a different pattern from that observed inTable 3.