Abstract
Differences in mortality between groups with different socioeconomic positions (SEP) are well-established, but the relative contribution of different SEP measures is unclear. This study compares the correlation between three SEP dimensions and mortality, and investigates differences between gender and age groups (35–59 vs. 60–84). We use an 11% random sample with an 80% oversample of deaths from the Finnish population with information on education, occupational class, individual income, and mortality (n = 496,658; 274,316 deaths between 1995 and 2007). We estimate bivariate and multivariate Cox proportional hazard models and population attributable fractions. The total effects of education are substantially mediated by occupation and income, and the effects of occupation is mediated by income. All dimensions have their own net effect on mortality, but income shows the steepest mortality gradient (HR 1.78, lowest vs. highest quintile). Income is more important for men and occupational class more important among elderly women. Mortality inequalities are generally smaller in older ages, but the relative importance of income increases. In health inequality studies, the use of only one SEP indicator functions well as a broad marker of SEP. However, only analyses of multiple dimensions allow insights into social mechanisms and how they differ between population subgroups.
Highlights
Differences in health and mortality between groups with different socioeconomic positions (SEP) have been found in numerous studies and across gender, periods, ages, and countries (Elo 2009; Mackenbach et al 2015)
Our comparative study on the relationship between dimensions of SEP and mortality shows, first, that the association between education and mortality is substantially reduced by taking occupation and income into account
Looking at the remaining net effects, the effect of income is much larger than the effect of education and occupation
Summary
Differences in health and mortality between groups with different socioeconomic positions (SEP) have been found in numerous studies and across gender, periods, ages, and countries (Elo 2009; Mackenbach et al 2015). The core argument is that SEP is inherently multidimensional, and should not be measured with only one indicator; different measures should not be treated as interchangeable (Braveman et al 2005; Geyer et al 2006; Goldthorpe 2010), but should be studied both separately and in conjunction (Bukodi et al 2014). Our study contributes to this discussion by empirically examining the multivariate relations and associations between mortality and the three variables education, occupational class, and income in Finland, and assessing differences by gender and age
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