Socio-economic status and overall and cause-specific mortality in Sweden.

Marianne Weires,Kari Hemminki,Kristina Sundquist,Justo Lorenzo Bermejo,Jan Sundquist

doi:10.1186/1471-2458-8-340

Marianne Weires, Kari Hemminki + Show 3 more

Open Access

https://doi.org/10.1186/1471-2458-8-340

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Abstract

BackgroundPrevious studies have reported discrepancies in cause-specific mortality among groups of individuals with different socio-economic status. However, most of the studies were limited by the specificity of the investigated populations and the broad definitions of the causes of death. The aim of the present population-based study was to explore the dependence of disease specific mortalities on the socio-economic status in Sweden, a country with universal health care. Another aim was to investigate possible gender differences.MethodsUsing the 2006 update of the Swedish Family-Cancer Database, we identified over 2 million individuals with socio-economic data recorded in the 1960 national census. The association between mortality and socio-economic status was investigated by Cox's proportional hazards models taking into account the age, time period and residential area in both men and women, and additionally parity and age at first birth in women.ResultsWe observed significant associations between socio-economic status and mortality due to cardiovascular diseases, respiratory diseases, to cancer and to endocrine, nutritional and metabolic diseases. The influence of socio-economic status on female breast cancer was markedly specific: women with a higher socio-economic status showed increased mortality due to breast cancer.ConclusionEven in Sweden, a country where health care is universally provided, higher socio-economic status is associated with decreased overall and cause-specific mortalities. Comparison of mortality among female and male socio-economic groups may provide valuable insights into the underlying causes of socio-economic inequalities in length of life.

Highlights

Previous studies have reported discrepancies in cause-specific mortality among groups of individuals with different socio-economic status
Data on socioeconomic status and mortality are sparse and most studies are limited by the specificity of the investigated populations and by the broad definitions of the causes of death [3,4,6,7,8,10,16,20]
Female and male overall and cause-specific mortality rate ratios/ Hazard Ratio (HR) according to socio-economic status are presented in Table 1 to Table 6

Summary

Introduction

Previous studies have reported discrepancies in cause-specific mortality among groups of individuals with different socio-economic status. The aim of the present population-based study was to explore the dependence of disease specific mortalities on the socio-economic status in Sweden, a country with universal health care. Another aim was to investigate possible gender differences. This study investigates socio-economic differences among the most common causes of death taking advantage of the nationwide Swedish Family-Cancer Database. There is some evidence that a socio-economic gradient in cancer survival is present in Sweden, it is still unclear to what extent the socio-economic status influences other disease specific mortalities in a country with universal health care [21,22,3,8,11]. It is important to notice here that the structure of the Database (Swedes born after 1931 with their biological parents), together with the restriction of the analyses to individuals aged 30–60 years in the Swedish census of 1960, resulted in a study population where all individuals were parents

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