Social Inequality In Mortality Research Articles

Social inequality in mortality associated with neurodegeneration: a population-based study in Belgium

Abstract Background Worldwide, population is ageing, leading to a growing burden of neurodegenerative diseases (NDDs) such as Alzheimer's Disease (AD), Parkinson's Disease (PD). Socioeconomic position (SEP) has shown a persistent negative relationship with mortality over the last decades. The most common indicators of SEP such as income, education, and occupational class have shown to significantly impact life expectancy and other mortality indicators. However, studies on the association between SEP and NDD mortality are rather scarce. Therefore, the aim of this study is to assess whether SEP is associated with NDD mortality, which is crucial in understanding and developing preventive interventions for these diseases. Methods A comparative analysis on SEP - in terms of income and education - and deaths associated with dementia and parkinsonism was performed, using log linear Poisson regression. Data consisted of the 2011 Belgian census linked to mortality data for the period 2011-2016. Results During the 2011-2016 study period, 34,700 Belgian inhabitants aged 65 or older died from an NDD (N = 1,883,182). We observed significantly higher mortality in the lowest educational- and income groups. Education had the strongest association in women, with 1.29 (CI 1.21-1.38) times the MRR in the lowest educated group compared to the highest. In men, income showed the strongest association with 1.11 (CI 1.04-1.18) times the MRR in the lowest income group compared to the highest. The biggest disparities were found in dementia mortality, generally negative association with SEP. For income, we observed a strong negative association on parkinsonism mortality, while we found a reversed pattern with education. Conclusions Our study provides evidence supporting the existence of socioeconomic disparities in mortality due to neurodegeneration. We found a strong negative association between SEP and NDD mortality, which varies between men and women and between several NDDs. Key messages • NDDs are rapidly becoming a major public health issue worldwide. • Mortality from these diseases vary between different social groups, differentiated interventions are needed in order to reduce inequalities.

Old-age mortality and social class in northern Norway in the first half of the twentieth century

ABSTRACT The number of studies on social inequality in mortality in Norway before 1960 is limited and they often focus on early life outcomes. Little is known about socioeconomic differences in old-age mortality before the emergence of the welfare state. Linked census and church records from the Historical Population Register of Norway were used to study a sample of 10,457 men and women born 1841–1870 who lived in Troms, a province in northern Norway, in the early twentieth century. We analysed the association between social class, measured in adulthood, and mortality at age 60 and older using Cox proportional hazards models. The results do not indicate a clear social gradient in mortality. Differences between social classes varied in the magnitude and direction of effects, depending on gender and place of residence. For women, the association between social class and mortality was weaker overall. Only farming was significantly associated with decreased mortality risk compared to the group of lower-skilled and unskilled workers. Differences were more pronounced among men, with higher mortality for non-manual classes in towns, and lower mortality for skilled workers and farmers in rural areas. The advantage for farmers was amplified in combination with manual or non-manual work.

Trends in social inequality in mortality in Denmark 1995–2019: the contribution of smoking- and alcohol-related deaths

BackgroundDuring the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate...

Beslaag, fleuris en roeeëdfônk. Een analyse van het doodsoorzakenpatroon in Maaseik, 1881-1885

In late 19th century Maaseik, a small rural town in Belgian Limburg, individual cause of death registers have been preserved until today. This is very unusual, since the registers were often destroyed because of privacy reasons. In this research I examine the cause of death pattern in adults and elderly people in Maaseik during the years 1881-1885, using descriptive statistics. During this period 475 deaths were reported and for 76 percent of them, the cause of death and other information about the persons in question are available. I look at the mortality of Maaseik with reference to three prominent theories in historical mortality research: the urban mortality penalty, the epidemiological transition theory and social inequality in mortality. Statistical analyses shows that the urban mortality penalty was also present in a small town as Maaseik, even though the environment was overall healthier than in highly industrialized or urbanized areas. With regard to the epidemiological transition, I note that degenerative diseases were already prevalent in the late 19th century. Regarding the social inequality in death, I find that people of middle and higher social classes were often affected by other health risks than lower classes.

Mediating role of multimorbidity in inequality in mortality: a register study on the Danish population

BackgroundThe social inequality in mortality is due to differential incidence of several disorders and injury types, as well as differential survival. The resulting clustering and possible interaction in disadvantaged groups...

Inequality in mortality in pre-industrial southern Europe during an epidemic episode: socio-economic determinants (eighteenth - nineteenth centuries Spain)

The objective of this study is to gain more comprehensive knowledge about social inequality in mortality in pre-industrial periods. With this aim, we have reconstructed the life courses of the inhabitants of the town of Vera in south-east Spain for the period 1797–1812 in order to estimate the influence of socio-economic status on ordinary and extraordinary mortality, given that, during this period, the town suffered from several epidemic outbreaks of yellow fever. As a result of these outbreaks, around a quarter of the town’s population died. The results obtained indicate social inequality in mortality at least from the end of the eighteenth century. Although the differences are higher in mortality caused by non-infectious diseases or ill-defined causes, the coefficients also show a certain social gradient in mortality derived from infectious diseases. However, with respect to this latter type of mortality, the place of residence - seems to have a greater influence on the chances of survival than socio-economic status.

Social Inequality by Income in Short- and Long-Term Cause-Specific Mortality after Stroke

Goals: It is unclear whether social inequality exists for mortality after stroke. Results of studies on the relation between socioeconomic position (SEP) and mortality after stroke have been inconsistent and inconclusive. Material and Methods: We studied the association between SEP expressed by income and the risk of death after stroke by merging data on incident stroke from Danish registries with nationwide coverage. We identified all incident cases of stroke hospitalized in Denmark 2003-2012 (n = 60503). Patients were followed up to 9 years after stroke (median 2.6 years). Adjusting for age and sex we studied all-cause death and cause-specific death by stroke, cardiac disease, cancer, and other diseases certified by death records and stratified by income. Results: Of the patients 20,953 (34.6%) had died within follow-up: Death by stroke 8018 (13.2%); cardiac disease 4250 (7.0%); cancer 3060 (5.0%); other diseases 5625 (9.2%). Long-term mortality rates were inversely related to income for all causes of death. The difference in mortality between the lowest and the highest income group at 5 years after stroke was 15.5% (relative) and 5.7% (absolute). Differences in short-term mortality (1-month to 1-year) between income groups were small and clinically insignificant. Conclusions: Social inequality in mortality after stroke expressed by income was pronounced for long-term mortality while not for short-term mortality. It seems that social inequality is expressed in a greater risk among stroke patients with low income for the advent of new diseases subsequently leading to death rather than in their ability to survive the incident stroke.

Estimating social inequality in mortality and life expectancy in absence of register data in Germany

Estimating social inequality in mortality and life expectancy in absence of register data in Germany

Large and Growing Social Inequality in Mortality in Norway: The Combined Importance of Marital Status and Own and Spouse's Education

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What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark? A nationwide register-based study

ObjectivesThe aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985–2009.DesignA nationwide...

Comparing progress toward the millennium development goal for under-five mortality in León and Cuatro Santos, Nicaragua, 1990–2008

BackgroundSocial inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua.MethodsThe study was conducted in one rural (Cuatro Santos) and one urban/rural area (León) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy).ResultsUnder-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban León showed greater reduction (AARR = 8.5%) in mortality and inequality than rural León (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural León and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases.ConclusionsAll rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings.

P1-337 Social inequality in mortality: causality or selection?

IntroductionThe aim of this study was to examine to which degree the often demonstrated association between educational status and mortality is confounded by family characteristics, that is environment in childhood...

Long-term changes in social mortality differentials, Geneva, 1625–2004

In this paper we argue that in order to test competing hypotheses on the emergence of social mortality differentials, one has to adopt a long-term perspective. Studying social inequality in mortality in Geneva from 1625 to 2005, we use historical mortality data published by different authors and contemporary data drawn from an ongoing research project. The comparison over four centuries gives evidence to both the constancy and convergence hypotheses. Mortality is systematically lower-than-average among elites on the one hand, but on the other hand the difference between the top and the bottom of the social ladder is decreasing over time.

Wealth and health in 19th Century Sweden. A study of social differences in adult mortality in the Sundsvall region

Abstract The present article analyses social inequality in mortality in the 19th century Sundsvall region, an area that experienced rapid industrialization after 1850. The purpose of the study is to investigate whether there were social differences in mortality in this context and whether these differences increased during the industrial break-through. The expected advantages for higher social classes could not be confirmed in this environment. Instead, the best survival was found among those belonging to the agricultural sector. We found a strongly gendered pattern, with much higher mortality for and small health differences among men, while the results indicate increasing social inequality in female mortality during industrialization. The spatial pattern of mortality was pronounced and living with a partner had a strong impact on survival, particularly for men. We finally discuss the role of gender and class expectations in relation to lifestyles for the social patterning of mortality.

Increasing social inequality in life expectancy in Denmark

The purpose of the study was to determine trends in social inequality in mortality and life expectancy in Denmark. The study was based on register data on educational level and mortality during the period 1981-2005 and comprised all deaths among Danes aged 30-60. Sex- and age-specific death rates for each of three levels of education were calculated and age-standardized to allow comparisons over time and between groups. As data obtained since 1996 included ages up to 74, partial life expectancy (i.e. expected lifetime of 30-year-olds before the age of 75) was calculated for the period 1996-2005. Between 1981 and 2005, the difference in death rates between people aged 30-60 with low and high educational level increased by two-thirds for men and was doubled for women. During the period 1996-2005, the gap in partial life expectancy from age 30 to 75 between people with low and high educational level increased by 0.3 years. During the past 25 years, the social gap in mortality has widened in Denmark. In particular, women with a low educational level have been left behind.

Life-course influences on mortality at older ages: Evidence from the Oslo Mortality Study

Several studies have investigated the cumulative influence of disadvantage acting from early to adult life. And they suggest that risk of death increases in a cumulative fashion. Few studies have investigated the life-course influences on social inequality in mortality in early old age. In this study we wanted to follow a cohort through their adult working age into retirement and investigate pathways that may give increased risk of mortality. A cohort of all inhabitants in the age range 68–72 who lived in the municipality of Oslo on 1st January 1990 was selected. Data were obtained by linking censuses from 1960, 1970 and 1980 with tax registry in 1990 and death registry 1990–1998. Independent variables were occupational class in 1960, 1970 and 1980 and household income in 1990. Occupational class was coded as manual and non-manual and household income as above or below median household income. A cumulative model was developed by adding times of disadvantage. Then a pathway model was developed which investigated the specific trajectories individuals followed. Most of the increased risk of death was explained by individuals’ social conditions in 1990. In the cumulative model, there was no clear gradient in the groups between the bottom and top categories. This suggests that the cumulative model is not important in the high mortality age and that the relative importance of a cumulative effect varies by stages of the life course.

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.

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

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.