International Journal of Epidemiology 2003;32:830-837
© International Epidemiological Association 2003
Inequality |
Widening socioeconomic inequalities in mortality in six Western European countries
1 Department of Public Health, Erasmus MC, The Netherlands.
2 Statistics Denmark, Copenhagen, Denmark.
3 Department of Social Sciences, Turin University, Italy.
4 Department of Public health and Microbiology, Turin University, Italy.
5 Medical Statistics, Office for National Statistics, London, UK.
6 SU-KI Centre for Health Equity Studies, Stockholm University, Sweden.
7 Department of Sociology, University of Helsinki, Finland.
Prof. Dr JP Mackenbach, Erasmus MC, Department of Public Health, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: j.mackenbach{at}erasmusmc.nl
Objectives During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality.
Methods We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981–1985 and 1991–1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations).
Results Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries.
Conclusions Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.
Accepted 23 April 2003
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. N. Arendt and J. Lauridsen Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health? Eur J Public Health, April 1, 2008; 18(2): 131 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Fors, C. Lennartsson, and O. Lundberg Health inequalities among older adults in Sweden 1991-2002 Eur J Public Health, April 1, 2008; 18(2): 138 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Harald, S Koskinen, P Jousilahti, J Torppa, E Vartiainen, and V Salomaa Changes in traditional risk factors no longer explain time trends in cardiovascular mortality and its socioeconomic differences J. Epidemiol. Community Health, March 1, 2008; 62(3): 251 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Borrell, E Azlor, M Rodriguez-Sanz, R Puigpinos, G Cano-Serral, M I Pasarin, J M Martinez, J Benach, and C Muntaner Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century J. Epidemiol. Community Health, March 1, 2008; 62(3): 258 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Blakely, M. Tobias, and J. Atkinson Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies BMJ, February 16, 2008; 336(7640): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S E Ramsay, R W Morris, L T Lennon, S G Wannamethee, and P H Whincup Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men J. Epidemiol. Community Health, January 1, 2008; 62(1): 75 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bronnum-Hansen and M. Baadsgaard Increasing social inequality in life expectancy in Denmark Eur J Public Health, December 1, 2007; 17(6): 585 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Menvielle, A. Leclerc, J.-F. Chastang, M. Melchior, D. Luce, and for the Evolution Des Inegalites Sociales Par Caus Changes in Socioeconomic Inequalities in Cancer Mortality Rates Among French Men Between 1968 and 1996 Am J Public Health, November 1, 2007; 97(11): 2082 - 2087. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Reddy, D. Prabhakaran, P. Jeemon, K. R. Thankappan, P. Joshi, V. Chaturvedi, L. Ramakrishnan, and F. Ahmed Educational status and cardiovascular risk profile in Indians PNAS, October 9, 2007; 104(41): 16263 - 16268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Albano, E. Ward, A. Jemal, R. Anderson, V. E. Cokkinides, T. Murray, J. Henley, J. Liff, and M. J. Thun Cancer Mortality in the United States by Education Level and Race J Natl Cancer Inst, September 19, 2007; 99(18): 1384 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Piha, P. Martikainen, O. Rahkonen, E. Roos, and E. Lahelma Trends in socioeconomic differences in sickness absence among Finnish municipal employees 1990--99 Scand J Public Health, August 1, 2007; 35(4): 348 - 355. [Abstract] [PDF]
|
|
|
|
|
|
N. E. Maki and P. T. Martikainen Socioeconomic differences in suicide mortality by sex in Finland in 1971--2000: A register-based study of trends, levels, and life expectancy differences Scand J Public Health, August 1, 2007; 35(4): 387 - 395. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Laaksonen, P. Martikainen, E. Lahelma, T. Lallukka, O. Rahkonen, J. Head, and M. Marmot Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study Int. J. Epidemiol., August 1, 2007; 36(4): 776 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Martikainen, J. Blomgren, and T. Valkonen Change in the total and independent effects of education and occupational social class on mortality: analyses of all Finnish men and women in the period 1971-2000 J. Epidemiol. Community Health, June 1, 2007; 61(6): 499 - 505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Decker and I. J. Higginson A tale of two cities: Factors affecting place of cancer death in London and New York Eur J Public Health, June 1, 2007; 17(3): 285 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kivimaki, D. A. Lawlor, G. D. Smith, A. Kouvonen, M. Virtanen, M. Elovainio, and J. Vahtera Socioeconomic Position, Co-Occurrence of Behavior-Related Risk Factors, and Coronary Heart Disease: the Finnish Public Sector Study Am J Public Health, May 1, 2007; 97(5): 874 - 879. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Aittomaki, E. Lahelma, O. Rahkonen, P. Leino-Arjas, and P. Martikainen The contribution of musculoskeletal disorders and physical workload to socioeconomic inequalities in health Eur J Public Health, April 1, 2007; 17(2): 145 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Pearce, K. Witten, R. Hiscock, and T. Blakely Are socially disadvantaged neighbourhoods deprived of health-related community resources? Int. J. Epidemiol., April 1, 2007; 36(2): 348 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Saracci Epidemiology: a science for justice in health Int. J. Epidemiol., April 1, 2007; 36(2): 265 - 268. [Full Text] [PDF]
|
|
|
|
|
|
J Fawcett and T Blakely Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981-99) J. Epidemiol. Community Health, January 1, 2007; 61(1): 59 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Melchior, L F Berkman, I Kawachi, N Krieger, M Zins, S Bonenfant, and M Goldberg Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study. J. Epidemiol. Community Health, November 1, 2006; 60(11): 937 - 944. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Lahelma Health inequalities--the need for explanation and intervention. Eur J Public Health, August 1, 2006; 16(4): 339 - 339. [Full Text] [PDF]
|
|
|
|
|
|
L. Kestila, S. Koskinen, T. Martelin, O. Rahkonen, T. Pensola, H. Aro, and A. Aromaa Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education? Eur J Public Health, June 1, 2006; 16(3): 305 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Pearce and D. Dorling Increasing geographical inequalities in health in New Zealand, 1980-2001 Int. J. Epidemiol., June 1, 2006; 35(3): 597 - 603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N Rasmussen, S. Rasmussen, G. H Gislason, P. Buch, S. Z Abildstrom, L. Kober, M. Osler, F. Diderichsen, C. Torp-Pedersen, and M. Madsen Mortality after acute myocardial infarction according to income and education. J. Epidemiol. Community Health, April 1, 2006; 60(4): 351 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Marmot Status Syndrome: A Challenge to Medicine JAMA, March 15, 2006; 295(11): 1304 - 1307. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Sekine, T. Chandola, P. Martikainen, D. McGeoghegan, M. Marmot, and S. Kagamimori Explaining social inequalities in health by sleep: the Japanese civil servants study J. Public Health Med., March 1, 2006; 28(1): 63 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Tunstall-Pedoe, M Woodward, and for the SIGN group on risk estimation By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease Heart, March 1, 2006; 92(3): 307 - 310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Galobardes, M. Shaw, D. A Lawlor, J. W Lynch, and G. Davey Smith Indicators of socioeconomic position (part 2) J. Epidemiol. Community Health, February 1, 2006; 60(2): 95 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Rognerud and P.-H. Zahl Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period Eur J Public Health, February 1, 2006; 16(1): 62 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A J Houweling, A. E Kunst, G. Borsboom, and J. P Mackenbach Mortality inequalities in times of economic growth: time trends in socioeconomic and regional inequalities in under 5 mortality in Indonesia, 1982-1997 J. Epidemiol. Community Health, January 1, 2006; 60(1): 62 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Regidor, E. Ronda, C. Pascual, D. Martinez, M. E. Calle, and V. Dominguez Decreasing Socioeconomic Inequalities and Increasing Health Inequalities in Spain: A Case Study Am J Public Health, January 1, 2006; 96(1): 102 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Simpson, I. Janssen, W. M Craig, and W. Pickett Multilevel analysis of associations between socioeconomic status and injury among Canadian adolescents J. Epidemiol. Community Health, December 1, 2005; 59(12): 1072 - 1077. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P Tsai, J. K Wendt, R. P Donnelly, G. de Jong, and F. S Ahmed Age at retirement and long term survival of an industrial population: prospective cohort study BMJ, October 29, 2005; 331(7523): 995. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hemmingsson and I. Lundberg Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility? Eur J Public Health, October 1, 2005; 15(5): 518 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Shaw, T. Blakely, J. Atkinson, and P. Crampton Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981-1999 J. Epidemiol. Community Health, August 1, 2005; 59(8): 638 - 644. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W Pickett, M Molcho, K Simpson, I Janssen, E Kuntsche, J Mazur, Y Harel, and W F Boyce Cross national study of injury and social determinants in adolescents Inj. Prev., August 1, 2005; 11(4): 213 - 218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Smith Infection, medical care and inequalities Int. J. Epidemiol., June 1, 2005; 34(3): 507 - 508. [Full Text] [PDF]
|
|
|
|
|
|
P. Jousilahti, V. Salomaa, K. Kuulasmaa, M. Niemela, and E. Vartiainen Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women J. Epidemiol. Community Health, April 1, 2005; 59(4): 310 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Yarnell, S Yu, E McCrum, D Arveiler, B Hass, J Dallongeville, M Montaye, P Amouyel, J Ferrieres, J-B Ruidavets, et al. Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: the PRIME Study Int. J. Epidemiol., April 1, 2005; 34(2): 268 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hemmingsson and I. Lundberg How far are socioeconomic differences in coronary heart disease hospitalization, all-cause mortality and cardiovascular mortality among adult Swedish males attributable to negative childhood circumstances and behaviour in adolescence? Int. J. Epidemiol., April 1, 2005; 34(2): 260 - 267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E Kunst, V. Bos, E. Lahelma, M. Bartley, I. Lissau, E. Regidor, A. Mielck, M. Cardano, J. A. Dalstra, J. J. Geurts, et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries Int. J. Epidemiol., April 1, 2005; 34(2): 295 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Laaksonen, E. Roos, O. Rahkonen, P. Martikainen, and E. Lahelma Influence of material and behavioural factors on occupational class differences in health J. Epidemiol. Community Health, February 1, 2005; 59(2): 163 - 169. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E Kunst Commentary: Using geographical data to monitor socioeconomic inequalities in mortality: experiences from Japanese studies Int. J. Epidemiol., February 1, 2005; 34(1): 110 - 112. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Avendano, A. E. Kunst, F. van Lenthe, V. Bos, G. Costa, T. Valkonen, M. Cardano, S. Harding, J-K. Borgan, M. Glickman, et al. Trends in Socioeconomic Disparities in Stroke Mortality in Six European Countries between 1981-1985 and 1991-1995 Am. J. Epidemiol., January 1, 2005; 161(1): 52 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Marinacci, T Spadea, A Biggeri, M Demaria, A Caiazzo, and G Costa The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy J. Epidemiol. Community Health, March 1, 2004; 58(3): 199 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Davey Smith Uncertainty and significance Int. J. Epidemiol., October 1, 2003; 32(5): 683 - 683. [Full Text] [PDF]
|
|
|
|
|
|
S. Koskinen Commentary: Is there a common background behind growing inequalities in mortality in Western European countries? Int. J. Epidemiol., October 1, 2003; 32(5): 838 - 839. [Full Text] [PDF]
|
|