Educational inequalities in mortality and associated risk factors: German- versus French-speaking Switzerland

David Faeh,Matthias Bopp

doi:10.1186/1471-2458-10-567

Abstract

BackgroundBetween the French- and German-speaking areas of Switzerland, there are distinct differences in mortality, similar to those between Germany and France. Assessing corresponding inequalities may elucidate variations in mortality and risk factors, thereby uncovering public health potential. Our aim was to analyze educational inequalities in all-cause and cause-specific mortality in the two Swiss regions and to compare this with inequalities in behavioural risk factors and self-rated health.MethodsThe Swiss National Cohort, a longitudinal census-based record linkage study, provided mortality and survival time data (3.5 million individuals, 40-79 years, 261,314 deaths, 1990-2000). The Swiss Health Survey 1992/93 provided cross-sectional data on risk factors. Inequalities were calculated as percentage of change in mortality rate (survival time, hazard ratio) or risk factor prevalence (odds ratio) per year of additional education using multivariable Cox and logistic regression.ResultsSignificant inequalities in mortality were found for all causes of death in men and for most causes in women. Inequalities were largest in men for causes related to smoking and alcohol use and in women for circulatory diseases. Gradients in all-cause mortality were more pronounced in younger and middle-aged men, especially in German-speaking Switzerland. Mortality inequalities tended to be larger in German-speaking Switzerland whereas inequalities in associated risk factors were generally more pronounced in French-speaking Switzerland.ConclusionsWith respect to inequalities in mortality and associated risk factors, we found characteristic differences between German- and French-speaking Switzerland, some of which followed gradients described in Europe. These differences only partially reflected inequalities in associated risk factors.

Highlights

Between the French- and German-speaking areas of Switzerland, there are distinct differences in mortality, similar to those between Germany and France
Educational inequalities in mortality were substantial in Switzerland, for causes with known risk factors
Since risk factors often occur together, their joint impact may better correspond to the inequality in mortality

Summary

Introduction

Between the French- and German-speaking areas of Switzerland, there are distinct differences in mortality, similar to those between Germany and France. Our aim was to analyze educational inequalities in all-cause and cause-specific mortality in the two Swiss regions and to compare this with inequalities in behavioural risk factors and self-rated health. Even when adequate data are available, it can still be difficult to assess inequalities because of nationally different definitions of socio-economic status (SES) and substantial variation regarding assignment of causes of death or Regional comparisons may identify potential for reduction of inequalities. A recent comparison showed characteristic variations in causespecific mortality and risk factors between the Germanand French-speaking areas of Switzerland reflecting broader European patterns [7]. Such variations indicate unexploited potential for reduction of health inequalities. Economic and wealth parameters are comparable, except of a slightly higher unemployment rate in French-speaking Switzerland

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