Abstract
BackgroundEducational inequalities in total mortality in Norway have widened during 1960–2000. We wanted to investigate if inequalities have continued to increase in the post millennium decade, and which causes of deaths were the main drivers.MethodsAll deaths (total and cause specific) in the adult Norwegian population aged 45–74 years over five decades, until 2010 were included; in all 708,449 deaths and over 62 million person years. Two indices of inequalities were used to measure inequality and changes in inequalities over time, on the relative scale (Relative Index of Inequality, RII) and on the absolute scale (Slope Index of Inequality, SII).ResultsRelative inequalities in total mortality increased over the five decades in both genders. Among men absolute inequalities stabilized during 2000–2010, after steady, significant increases each decade back to the 1960s, while in women, absolute inequalities continued to increase significantly during the last decade. The stabilization in absolute inequalities among men in the last decade was mostly due to a fall in inequalities in cardiovascular disease (CVD) mortality and lung cancer and respiratory disease mortality. Still, in this last decade, the absolute inequalities in cause-specific mortality among men were mostly due to cardiovascular diseases (CVD) (34% of total mortality inequality), lung cancer and respiratory diseases (21%). Among women the absolute inequalities in mortality were mostly due to lung cancer and chronic lower respiratory tract diseases (30%) and CVD (27%).ConclusionsIn men, absolute inequalities in mortality have stopped increasing, seemingly due to reduction in inequalities in CVD mortality. Absolute inequality in mortality continues to widen among women, mostly due to death from lung cancer and chronic lung disease. Relative educational inequalities in mortality are still on the rise for Norwegian men and women.
Highlights
Educational inequalities in total mortality in Norway have widened during 1960–2000
Relative inequalities (RII) increased sharply in men and women in all decades (p < 0.001), except from 1970s to 1980s in women where inequalities were stable (Table 2). Another noteworthy change in the post millennium decade from previous decades was the large drop in absolute inequality in cardiovascular disease (CVD) mortality among men; the Slope Index of Inequality (SII) for CVD dropped from 508 to 357 deaths per 100,000 (Figure 1a)
There was a drop in CVD mortality for all educational groups the last decades, in both men and women, and in the last decade this drop was greatest in the lowest educational group (Table 3)
Summary
We wanted to investigate if inequalities have continued to increase in the post millennium decade, and which causes of deaths were the main drivers. Even in the Nordic countries, where the welfare state regime is generous with a focus on equality, there have been widening inequalities in the last decades, both on an absolute and a relative scale [2,3,4]. We reported widening educational inequalities (both relative and absolute) in mortality among middle aged Norwegians in the period 1960–2000 [2]. The increase in inequality during the period was driven by cardiovascular mortality in men, and by deaths due to chronic lower respiratory tract diseases and lung cancer in women. Using national cause specific mortality data, we build on our previous work to examine if the educational inequalities in mortality in Norway have continued to increase after the millennium, and which causes are important regarding the educational inequalities
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