Abstract
BackgroundCause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics.MethodsUsing age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to “Symptoms, signs and ill-defined conditions”. We tested if this proportion differed across educational groups using Chi-square tests.ResultsThe proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people.ConclusionsWe found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1295) contains supplementary material, which is available to authorized users.
Highlights
Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries
The proportion ranged from 0.1% in Hungary to 6.2% in Poland among men, and from 0.05% in Hungary to 4.3% in the Netherlands among women. For both men and women, proportions of ill-defined causes of death lower than 1% were found in Finland, England and Wales, Scotland, Austria, Italy, Hungary, Czech Republic and Lithuania
The distribution of ill-defined causes of death differed by educational level in Denmark, England and Wales, Belgium, Hungary, Czech Republic, Poland and Estonia among men, and in Poland among women with the tendency of a higher proportion among low educated, and in Switzerland and Italy with the tendency of a higher proportion among high educated (Table 1)
Summary
Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. A Dutch study reported higher mortality due to ill-defined conditions in low-income boroughs of Amsterdam [15], studies investigating socioeconomic differences in the proportion of ill-defined causes of death are rare and were not conducted in such extent as our study does. Such inequalities may occur, for example, if lower socioeconomic groups have less access to good quality health care [16,17] and, as a consequence, die under circumstances in which their diagnosis is less well-established than is normally the case for patients with a higher socioeconomic position
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