Trends in socioeconomic mortality differentials in post‐war Norway: evidence and interpretations

Abstract

AbstractThe aim of the study was to describe changes in socioeconomic mortality differentials among adults in post‐war Norway and to examine some selected interpretations. Three separate data sets were obtained. In each set, census information on occupational class was linked to subsequent mortality during three five‐year periods, 1960–65, 1970–75 and 1980–85. The analysis showed a general decline in mortality but an increase in the socioeconomic mortality differentials among men, as measured by standardised mortality ratios (SMR). Women, however, displayed inconsistent SMR patterns and no clear trends. It is argued that this is due to an artefact, ie classification by women's own occupational class, and to health‐related exits from the labour market. Women were thus excluded from the analysis that followed. Over the years covered, socioeconomic age‐specific mortality differentials decreased among younger men and increased among older men. To mirror these changes, ‘potential years of life lost’ (PYLL) were calculated. Essentially, PYLL rendered the same picture as SMR did. The size of the increase in mortality differentials, as measured by SMR and PYLL, among men was somewhat underestimated due to health‐related exits from the work force, especially among unskilled workers, ie a ‘healthy worker effect’. A distinct change took place in the balance between the occupational groups at the extremes in the occupational structure over the years in question. This led to fewer deaths occurring among unskilled workers. Still, however, it seemed justified to state that social inequality in mortality remains a severe health problem. Little evidence was found of the hypothesised cohort effects.