IJE Advance Access originally published online on December 3, 2008
International Journal of Epidemiology 2009 38(2):512-525; doi:10.1093/ije/dyn248
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Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000
Kaldien5
1 Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University, Huddinge, Sweden.
2 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
3 Department of Epidemiology and Biostatistics, The National Institute for Health Development, Tallinn, Estonia.
4 Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden.
5 Faculty of Public Health, Kaunas University of Medicine, Kaunas, Lithuania.
6 Demographic Research Institute, HCSO, Budapest, Hungary.
7 Department of Medical Statistics, National Institute of Hygiene, Warsaw, Poland.
8 Institute of Statistics and Demography, Warsaw School of Economics, Warsaw, Poland.
* Corresponding author. Stockholm Centre on Health of Societies in Transition, (SCOHOST), Södertörn University, 141 89 Huddinge, Sweden. E-mail: mall.leinsalu{at}sh.se
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Abstract |
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Background Post-communist transition has had a huge impact on mortality in Eastern Europe. We examined how educational inequalities in mortality changed between 1990 and 2000 in Estonia, Lithuania, Poland and Hungary.
Methods Cross-sectional data for the years around 1990 and 2000 were used. Age-standardized mortality rates and mortality rate ratios (for total mortality only) were calculated for men and women aged 35–64 in three educational categories, for five broad cause-of-death groups and for five (seven among women) specific causes of death.
Results Educational inequalities in mortality increased in all four countries but in two completely different ways. In Poland and Hungary, mortality rates decreased or remained the same in all educational groups. In Estonia and Lithuania, mortality rates decreased among the highly educated, but increased among those of low education. In Estonia and Lithuania, for men and women combined, external causes and circulatory diseases contributed most to the increasing educational gap in total mortality.
Conclusions Different trends were observed between the two former Soviet republics and the two Central Eastern European countries. This divergence can be related to differences in socioeconomic development during the 1990s and in particular, to the spread of poverty, deprivation and marginalization. Alcohol and psychosocial stress may also have been important mediating factors.
Keywords Eastern Europe, mortality, inequalities, transition
Accepted 27 October 2008
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