Social Mortality Differentials Research Articles

Trends and social differentials in child mortality in Rwanda 1990-2010: results from three demographic and health surveys.

BackgroundRwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010.MethodsWe performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15–49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method.ResultsMortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005–2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR.ConclusionsRecent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.

Social mortality differentials in Denmark and the USA – Very different or very similar? A reply to Avendano and Galama

Social mortality differentials in Denmark and the USA – Very different or very similar? A reply to Avendano and Galama

Gender differences in social mortality differentials in Switzerland (1990-2005)

Using data from the 1990 and 2000 Swiss Federal Censuses linked to the death records of the years 1990-1995 and 2000-2005, this paper investigates gender differences in mortality differentials by level of educational achievement and by marital status.

Economic Inequality and Social Differentials in Mortality

Among the author's findings are that poor local populations pay a heavy toll in the loss of potentially productive members in their prime of life. However, important differences exist among and within persistently impoverished populations by race, gender, geographic location, and time period in the degree to which their poverty translates into excess mortality.

The Dialectics of Childhood Diarrhea Mortality

As in European countries a century ago, diarrhea is a major cause of child mortality in poor countries today. In Stockholm at the turn of the 19th century, political commitment, infrastructural investments in water and sanitation, and enforcement of sanitary improvements by a strong implementing organization helped eliminate diarrhea as a principal cause of death among children. These interventions also had an equitable impact on social class differences in diarrhea mortality, but not on overall mortality; overall mortality declined, but class differences remained. General infrastructural improvement and health education coupled with targeted interventions to vulnerable children may be successful in improving child health and reducing social differentials in mortality. Specific health care interventions may need to be complemented by infrastructural investments to improve water and sanitation if diarrhea mortality is to be further reduced in poor countries today.

Trends in alcohol intake by education and marital status in urban population in Russia between the mid 1980s and the mid 1990s.

We investigated changes in the distribution of alcohol consumption by education and marital status in Russia during the period of societal transformation after 1990. Such changes would indicate the potential role of alcohol in the rising social inequalities in mortality. We analysed data from three surveys in random population samples conducted in Novosibirsk as part of the WHO MONICA project in 1985/86 (1533 men, 1292 women), 1988/89 (1700 men, no women) and 1994/95 (1526 men, 1510 women), coinciding with the period of societal transformation. Four measures of drinking were examined in relation to education and marital status: prevalence of drinking at least twice a week; the mean intake in the last week; the mean intake per drinking occasion; and the prevalence of binge drinking (>80 g ethanol for men and >60 g for women) at least once a month. Among men, those with university education had the lowest levels of all measures of drinking. Drinking indices increased over time in all educational groups but most sharply in men with high education, thus leading to a smaller education-related difference in the last survey. With respect to marital status, divorced and widowed men tended to drink most, but the pattern was inconsistent, and the difference between divorced and married men also narrowed over time. Among women, alcohol intake increased between the first and last survey. Differences by education and marital status in women were smaller than in men, and binge drinking was inversely related to education. All indices of alcohol consumption in men increased between the mid 1980s and the mid 1990s. The increase in alcohol intake among men was proportionally similar across categories of education and marital status but the absolute differences increased. The contribution of alcohol to the increase in social differentials in mortality in the 1990s was probably modest.

Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study.

To assess the risk of death associated with work based and non-work based measures of socioeconomic status before and after retirement age. Follow up study of mortality in relation to employment grade and car ownership over 25 years. The first Whitehall study. 18,133 male civil servants aged 40-69 years who attended a screening examination between 1967 and 1970. Death. Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40-64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidence interval 2.4 to 4.1). After retirement the ability of grade to predict mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality less well than employment grade before retirement but its ability to predict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconomic groups showed employment grade and car ownership to have independent associations with mortality that were of equal magnitude after retirement. The absolute difference in death rates between the lowest and highest employment grades increased with age from 12.9 per 1000 person years at ages 40-64 to 38.3 per 1000 at ages 70-89. Socioeconomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based on an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an important part in generating social inequalities in health in men of working age.

Social inequality in mortality in São Paulo State, Brazil.

Epidemiological studies have consistently demonstrated social inequality to be an important factor in the distribution of illness and death in society. However, little work has been published on social differentials in mortality in the world's developing countries, where socioeconomic contrasts are often considerably greater. In order to evaluate the extent of social differentials in mortality in a setting of major social inequality -- the State of São Paulo, Brazil, deaths in men aged 15-64 years residing in São Paulo from 1980 to 1982 were linked in broad, occupationally-determined categories to estimates of population size based on the 1980 Brazilian national census. The occupational categorizations utilized a Brazilian classification scheme and additionally that of the British Registrar General. Mortality was 3.8 and 2.9 times greater comparing least to most socially favoured occupational category in each of the two classification systems, respectively. Independent of system, mortality decreased approximately 1.1% for each 1% increase along the occupationally-defined social gradient. This decrease was 48% greater than the equivalent calculated decrease for men of England and Wales. These data support the contention that mortality for Brazilian adults, even more so than for adults of the world's more economically developed nations, is inextricably bound to the issue of social equity.

Ecological and Social Differentials in Mortality: Inequalities by Metropolitan-Nonmetropolitan Residency and Racial Composition

Abstract Studies of differentials in mortality usually have been bivariate and without benefit of a theoretical structure. In this study, mortality is approached through a multivariate framework and conceptualized as an indicator of inequality resulting from differential life chances and styles, which, in turn, reflect general stratification processes. An ecological factor, residency, and a social factor, racial composition, are used to investigate four questions: Do metropolitan counties have lower death rates than nonmetropolitan counties? Does the difference between White and non-White county mortality still favor White counties, and will a racial differential favoring White-designated counties exist when residency status is held constant and when areal social class characteristics are held constant? All counties of the 12-state North Central Region (N = 1056) provide the data. T-test, covariance, and multiple classification analyses are used to investigate the questions. Metropolitan and White counties (with age controlled) displayed lower crude death rates. The latter two questions were answered strongly in the affirmative, indicating, not only that significant residency and racial differences in county mortality exist, but also that, even when controlled for residency status and areal social class, the racial differential persists. Conclusions support the use and conceptualization of mortality as an indicator of inequality. Discussion centers around the persistent racial differential and draws tentatively upon a “theory of insecurity” or “minority group status” hypothesis for explanation.