Causes of death responsible for the widening gap in mortality among educational groups in Austria between 1981 and 1991

Abstract

In Austria, educational differentials in all-cause mortality increased in the decade between 1981/82 and 1991/92. The aim of this study was to identify which causes of death contributed most to this increase. Census records for the Austrian population for the years 1981 and 1991 were linked with death register records for a follow-up period of one year. Education-related disparities in mortality were measured using regression-based indices to determine both absolute and relative levels of inequality at each timepoint and also the changes over the decade. Among men, increasing education-related disparity in deaths from ischemic heart disease was the major contributor to the change in disparity in overall mortality. Without this increase, mortality disparity would have declined, because modest increases in disparity among deaths from colorectal and lung cancers, and digestive and alcohol-associated diseases, were more than offset by reduction of disparity for cerebrovascular and other circulatory diseases, respiratory diseases and external causes. In women, increasing education-related disparity in deaths from ischemic heart disease also contributed most to the slight increase in absolute inequality in overall mortality, but diabetes and colorectal cancer also contributed significantly. In relative terms, there were striking increases in disparity for deaths from colorectal cancer and digestive diseases among men, and for diabetes deaths among women. The increase in mortality disparity for ischemic heart disease among men shows how rapidly social gradients in mortality can change. Public health measures concentrating on reversing increasing disparities would not only reduce the mortality gap between social classes but would have a very positive effect on average health status.