International Journal of Epidemiology, Vol 28, 899-904, Copyright © 1999 by International Epidemiological Association
P Martikainen and T Valkonen
BACKGROUND: To assess how the exclusion of the economically inactive
affects levels and trends in social class differences in mortality among
men and women at different durations of follow-up. METHODS: Records of the
1970, 1975, 1980 and 1985 censuses on Finnish men and women aged 35-64
linked with records of all deaths during 1971-1990. RESULTS: Exclusion of
the economically inactive population underestimates the class differences
in the total population by about 25% among men and 60% among women. The
bias does not disappear if the first 5 years of follow-up are excluded and
the bias can lead to erroneous conclusions about the trends in social class
differences in mortality. CONCLUSIONS: Analyses based on the economically
active population may lead to significant underestimation of social class
differences in mortality, introduce biases in international comparison and
may only partially capture the causal mechanisms underlying these mortality
differences. Our results further show that although the bias diminishes
during the follow-up, it is by no means eliminated after the first 5 years.
The underestimation of social class differences in mortality created by the
exclusion of the inactive should be more widely recognized and more
accurate data on previous occupations should be collected.
ARTICLES
Bias related to the exclusion of the economically inactive in studies on social class differences in mortality
Department of Sociology, University of Helsinki, Finland.
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