Socioeconomic inequalities in cause specific mortality among older people in France

Gwenn Menvielle,Danièle Luce,Annette Leclerc,Jean-François Chastang

doi:10.1186/1471-2458-10-260

Abstract

BackgroundEuropean comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). The aim of this paper is to investigate educational inequalities in mortality by gender, age and causes of death in France, with a special emphasis on people aged 75 years and more.MethodsWe used data from a longitudinal population sample that includes 1% of the French population. Risk of death (total and cause specific) in the period 1990-1999 according to education was analysed using Cox regression models by age group (45-59, 60-74, and 75+). Inequalities were quantified using both relative (ratio) and absolute (difference) measures.ResultsRelative inequalities decreased with age but were still observed in the oldest age group. Absolute inequalities increased with age. This increase was particularly pronounced for cardiovascular diseases. The contribution of different causes of death to absolute inequalities in total mortality differed between age groups. In particular, the contribution of cancer deaths decreased substantially between the age groups 60-74 years and 75 years and more, both in men and in women.ConclusionsThis study suggests that the large contribution of cancer deaths to the excess mortality among low educated people that was observed among middle aged men in Latin Europe is not observed among French people aged 75 years and more. This should be confirmed among other Latin Europe countries.

Highlights

European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy)
We investigated total mortality and specific causes of death: total cancers (ICD9:140-239), lung cancer (ICD9:162), colorectal cancer (ICD9:153-154), upper aerodigestive tract cancers (UADT) (ICD9:140-150,161), prostate cancer (ICD9:), breast cancer (ICD9:174), cardiovascular diseases (CVD) (ICD9:390-459), ischemic heart disease (IHD) (ICD9: 410-414), cerebrovascular disease (ICD9: 430-438), non cancer-non CVD (ICD9 codes not in 140-239 or 390-459) [13]
A reverse educational gradient was observed for total mortality and CVD mortality for all age groups both in men and women (Figure 1)

Summary

Introduction

European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). Socioeconomic inequalities in total and cause specific mortality have been consistently reported throughout Europe [1,2]. Within this general pattern, large differences are observed between countries both in the magnitude of these inequalities and in the weight of different causes of death in inequalities in total mortality. The main contributor to inequalities in total mortality was cancer in Latin Europe countries (France, Spain, Portugal and Italy), and cardiovascular diseases in Northern Europe, especially in Nordic countries [1,3].

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