Socioeconomic Differences In Mortality Research Articles

Socioeconomic and spatial differentials in mortality and means of committing suicide in New South Wales, Australia, 1985-91.

Analysis of suicide mortality in New South Wales, Australia is undertaken with reference to marital status and occupational status between 1986-89/90 and with reference to the principal means of committing suicide. Not currently married male manual workers were particularly at risk although marital status variations were significant with both genders and at different ages. Between 1985-91 male suicide mortality rates were significantly higher in inland non-metropolitan regions, especially among younger men, and were higher in inner areas of metropolitan Sydney. While there were no significant variations by marital status in the means of committing suicide there were variations between genders, and there were regional and social class variations in the use of guns with males. The use of guns was a factor in the elevated suicide mortality levels among inland rural youth and men, and among farmers and transport workers while the use of poisons was also significant with these occupational groups. The use of poisons was greater among persons committing suicide in the areas of elevated mortality in inner Sydney and the use of guns much lower.

Socio-economic differentials in infant and child mortality during mortality decline: England and Wales, 1890-1911.

In this paper data from the 1911 Census of the Fertility of Marriage of England and Wales are used to study patterns of mortality decline by socio-economic characteristics, principally the occupation of husband. That census reported data on number of wives, children ever born, and children dead by marriage-duration cohorts for 190 non-overlapping occupations of husband. These results, along with those on number of rooms in the dwelling of the family are used to make indirect estimates of childhood mortality using the techniques described in United Nations, Manual X. These procedures produce values of q(a), the probability of dying before reaching some exact age ‘a’. Estimates for q(2), q(3), q(5), q(10), q(15), and q(20) are derived from data on women married 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 years, respectively. These estimates can also be dated to a point in the past. These values can also be converted to a corresponding level of a Model West life table, which describes the ‘average’ mortality re...

Socioeconomic mortality differentials in men and women according to own and spouse's characteristics in Finland

AbstractThis paper compares the magnitude of differences in mortality according to own and spouse's socioeconomic characteristics and assesses the importance of cross‐classifying these characteristics. The analysis covers all 35–64 year‐old married Finnish men and women in the period 1981–85. Relative mortality rates were obtained from Poisson regression models.The analysis shows that socioeconomic mortality differentials within each sex are more or less equally large according to both own and spouse's education or occupational characteristics for a wide range of causes of death. Moreover, among both women and men cross‐classifications between own and spouse's socioeconomic status do not indicate important mortality differentials over and above those already displayed by its two separate parts, i.e. there were no important interactions between own and spouse's socioeconomic characteristics.The results call into question the argument that the mortality of married women should be analysed on the basis of their husband's socioeconomic characteristics because these characteristics better describe both spouses' socioeconomic standing and are thus more powerful predictors of men's and women's mortality than women's socioeconomic characteristics. It is further concluded that the advantages of cross‐classifying both spouses' socioeconomic characteristics in mortality analysis are very limited when these characteristics do not interact with each other.Moreover, cause‐specific comparisons between men and women showed that married women's mortality differentials by own educational as well as occupational status were roughly as large as those obtained for men. The larger total mortality differentials among men than women are mainly due to cause of death structure.

Causes of death contributing to urban socioeconomic mortality differences in Amsterdam.

Socioeconomic mortality differences exist between parts of many cities. This study aims to identify causes of death associated with such mortality differences and which preventive or curative interventions can modify. Associations were compared between socioeconomic status and age-standardized mortality by borough of Amsterdam, The Netherlands (n = 22) for causes of death grouped by feasible interventions. In men, mortality due to external and ill-defined causes occurs more frequently in low-income boroughs. In women, this holds for smoking-related and ill-defined causes. AIDS-related mortality is higher in boroughs with a high educational level. Mortality in low-income boroughs is generally higher for those causes of death which explain the relatively high urban mortality. Interventions to decrease urban socioeconomic mortality differences should be targeted on violence and accidents in men and smoking in women. Incomplete notification of deaths in low-income boroughs obscures some differences but also indicates problems in urban general practice and specific risks for immigrant residents. AIDS reduces the size of mortality differences among men, probably temporarily. Both feasibility and type of interventions are relevant for many urban areas.

Deprivation and mortality in Glasgow: changes from 1980 to 1992

Social class differentials in mortality in Britain increased between the early 1970s and early 1980s,1 and various indicators of increasing social polarisation since 1980 suggest that these mortality differentials will have widened further.2 Further widening is supported by analyses of area based mortality in the north of England which show that the differences in mortality between the most deprived and most affluent areas increased greatly between 1981 and 1991.3 Preliminary analyses from Glasgow showed a similar picture.4 We report the trends in socioeconomic mortality differentials in Greater Glasgow from 1980 to 1992. Numbers of deaths by sex and 10 year age band were available for 1980-82 and 1990-92 for people aged 15-64 residing in the area covered by the Greater Glasgow Health Board. Using the …

Cancer patient survival by socioeconomic status in seven countries: a review for six common cancer sites [corrected

To study the size and consistency of socioeconomic differences in cancer patient survival as reported in published studies. A systematic review was conducted. Several criteria were developed to select the study material, which resulted in 14 reports on socioeconomic differences in survival for cancers of the colon, rectum, lung, prostate, breast, and cervix. These present results on patients from the United States, Japan, Australia, United Kingdom, Sweden, Finland, and Germany. The results are summarised in a relative risk of dying or survival ratio for the lowest socioeconomic status group compared with the highest. For cancers of the colon, rectum, breast, and cervix, patients from higher socioeconomic status groups had a better survival. For lung cancer and cancer of the prostate, results were unclear. Socioeconomic differences in cancer survival are generally small and their contribution to socioeconomic differences in cancer mortality is probably small too. These findings have implications for the type of health policy measures which should be taken to reduce socioeconomic differences in cancer mortality.

Determinants of infant and early childhood mortality in Cameroon: the role of socioeconomic factors, housing characteristics, and immunization status.

This study examines factors impinging on the survival of children in Cameroon using longitudinal data collected by the United Nations Demographic Training and Research Institute of Yaoundé, Cameroon. It deals especially with the role of socioeconomic factors (mother's education, employment, marital status, ethnicity, and household income), housing characteristics (construction materials, power source, source of water supply, extent of crowding), and immunization status on infant and child mortality. Two-state parametric and nonparametric hazards models for the risk of death at any time within the course of the study are used, with and without accounting for unmeasured heterogeneity. Overall, overcrowding has robust deleterious effects on infant and child survival. As regards the effects of socioeconomic variables, the robustness of the effects of household income and ethnic differentials are unchanged, even after controlling for unmeasured heterogeneity; the deleterious effects of marital status are also apparent, but these effects are largely explained by unmeasured covariates. The data also suggest that the protective effects of full immunization status are robust and not contaminated by confounding factors, at least in the first 16 months of life. These findings provide solid ground to support immunization programs and efforts as a means to reduce significantly infant and child mortality.

Mortality by indicators of socioeconomic status among the finnish elderly

Socioeconomic mortality differentials among the entire Finnish elderly population (those aged 60 years and over) during 1981–85 are examined on the basis of linked data, compiled by means of linking death records of 1981–85 to the 1980 census. Several indicators of socioeconomic position are used: own educational level and occupational class, spouse's education and class, household disposable income, and housing conditions. Marked differences are found according to each of the indicators. Mortality differentials tend to decrease with age and be more pronounced among men as compared to women. In most cases differences persist even when the other socioeconomic indicators are taken into account although they diminish. The interpretation of socioeconomic mortality differentials and the problems of measuring the socioeconomic status of the elderly are discussed.

Why are socioeconomic mortality differences smaller among women than among men?

This study examines whether women's socioeconomic mortality differences appear to be smaller than those of men because of: (1) the choice of indicator used in measuring socioeconomic position; (2) the confounding influence of other sociodemographic variables, either masking women's inequities or accentuating them among men; or (3) differences in the cause of death structure between women and men. The data set is based on individual records of the 1980 census linked with death records for the period 1981–1985 in the 35–64-year old population in Finland. According to each of the socioeconomic indicators applied in this study (level of education, occupational class, housing density and standard of equipment of the dwelling) the relative magnitude of inequalities among women is considerably smaller than among men. This result arises totally from the married subpopulation—in other marital status groups women's inequalities are at least as large as men's. In most causes of death the socioeconomic mortality gradient is as steep or even steeper among women in comparison with men. When the cause of death structure of men is applied to the cause-specific mortality differences of women, the socioeconomic gradient in total mortality is almost similar among both genders even in the married population.

Explanations for socio-economic differentials in mortality

Socio-economic differentials in mortality are examined using the explanatory framework advanced by the Black Report. The evidence reviewed largely relates to studies carried out in Britain, although data from other European countries and the United States have also been considered. The many possible forms of artefactual distortion of associations between socio-economic status and mortality risk are examined and judged to have little effect; if anything, artefactual factors mean that conventional ideas about the magnitude of socio-economic differentials in mortality are an underestimate. Social selection is also considered to have little effect. Neither intragenerational downward drift nor direct intergenerational selection contribute significantly to the size of the differentials. Indirect selection has yet to be evaluated, although whether ft should be considered as a form of health selection rather than one form of accumulated disadvantage is unclear. Behavioural factors, while making important contributions to mortality risk, do not adequately account for the differences between social groups. Materialist factors, that is differential exposure to physical hazards determined by the distribution of income and opportunity, are an attractive explanatory category, since the persisting (or growing) socio-economic and geographical mortality differentials, seen during a period of broad secular declines in mortality rates, would be the anticipated outcome of their action. However, neither the social processes determining risk exposure nor the mechanisms by which exposures produce disease are well understood. Progress jn this area will depend upon studies which can examine how exposures interact and accumulate over the course of life to produce the observed pattern of mortality risk.

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.

Socio-economic factors and mortality in Switzerland.

This review paper is concerned with the topic of mortality differences by socio-economic group in Switzerland. After a short introduction to the topic and the pitfalls associated with it, the paper reviews work done in the course of a ten year programme investigating socio-economic mortality differentials in Switzerland. This programme was carried out by a working group at the Department of Social and Preventive Medicine of the University of Berne. The paper reviews methodological difficulties and pitfalls and relates the Swiss results to findings from other countries including England and Wales and Sweden. The disadvantages of socially isolated groups such as children of single women are shown. The relatively high mortality of groups under economic pressure, such as skilled manual workers in Switzerland, is demonstrated. The Swiss situation is interesting in that skilled manual workers have a higher mortality than the unskilled and semi-skilled groups. It is concluded that this is not an artifact but may be due to the fact that only Swiss workers were investigated and that Switzerland has a large proportion of foreign workers, especially in the less skilled groups. In addition, some results of an investigation of cancer mortality by occupation are reported too. Apart from some occupation-specific findings, there are some interesting cross-references to socio-economic differential mortality.

Why have child pedestrian death rates fallen?

Pedestrian injuries are a leading cause of childhood mortality and disability. Over the past two decades in Britain child pedestrian death rates have fallen despite large increases in traffic volume. In this paper Roberts examines the likely reasons for this decline. He argues that neither prevention programmes nor improvements in medical care are a plausible explanation and that the decline is most likely the result of a substantial reduction in children's traffic exposure. He believes, however, that restricting children's traffic exposure exacerbates socioeconomic differentials in childhood mortality and denies children their right to mobility. Roberts is convinced that one answer is for British transport policy to be aimed at providing mobility equitably rather than struggling to meet the ever increasing demands of car travel.

Explaining socioeconomic differences in sickness absence: the Whitehall II Study.

To describe and explain the socioeconomic gradient in sickness absence. Analysis of questionnaire and sickness absence data collected from the first phase of the Whitehall II study. Grade of employment was used as a measure of socioeconomic status. 20 civil service departments in London. 6900 male and 3414 female civil servants aged 35-55 years. Rates of short spells (< or = 7 days) and long spells (> 7 days) of sickness absence. A strong inverse relation between grade of employment and sickness absence was evident. Men in the lowest grade had rates of short and long spells of absence 6.1 (95% confidence interval 5.3 to 6.9) and 6.1 (4.8 to 7.9) times higher than those in the highest grade. For women the corresponding rate ratios were 3.0 (2.3 to 3.9) and 4.2 (2.5 to 6.8) respectively. Several risk factors were identified, including health related behaviours (smoking and frequent alcohol consumption), work characteristics (low levels of control, variety and use of skills, work pace, and support at work), low levels of job satisfaction, and adverse social circumstances outside work (financial difficulties and negative support). These risk factors accounted for about one third of the grade differences in sickness absence. Large grade differences in sickness absence parallel socioeconomic differences in morbidity and mortality found in other studies. Identified risk factors accounted for a small proportion of the grade differences in sickness absence. More accurate measurement of the risk factors may explain some of the remaining differences in sickness absence but other factors, as yet unrecognised, are likely to be important.

Problems in the measurement and international comparison of socio-economic differences in mortality

The opportunities for research of socio-economic differences in mortality are best in countries where a sytem of personal identification numbers makes the computerised linkage of census and death records possible. The first part of this study is an example of the use of such linked records. It presents results on the development of mortality differences by level of education and occupational class in Finland in the period 1971–1985. Socio-economic mortality differences among middle-aged and elderly men increased in Finland during the study period. The increase was mainly due to the rapid decline of mortality from cardiovascular disease among upper white-collar employees and men with more than secondary education. Relative socio-economic mortality differences were smaller among than among men and remained unchanged in 1971–1985. The second part of the article discusses the problems in international comparison of socio-economic mortality differences and summarises results from two comparative studies. The results are inconsistent: differences by level of education among men were found to be similar in six countries included in the comparison, whereas marked variation was found in the ratios of the mortality of manual workers to the mortality of non-manual workers.

Socioeconomic Differences in Fetal and Infant Mortality in Scandinavia

This study demonstrates that socioeconomic differences do exist in all three Scandinavian countries, and these differences have implications for perinatal and infant survival. Using parental education as a proxy for socioeconomic conditions, the association with perinatal survival seems to be stronger in Denmark and Norway than in Sweden. For postneonatal mortality the association is equally strong in the three countries. Data from one of the countries (Norway) demonstrates the joint importance of parental education, and the association with paternal education is equally strong as that with maternal education. If father and mother have the lowest level of education, their offspring has 50 to 80% higher perinatal and infant mortality risks. These observations call for further research into the association between social variables and health in order to tease out causal relationships which might lead to future preventive actions.

Socioeconomic differentials in mortality: evidence from Glasgow graveyards.

Socioeconomic differentials in mortality: evidence from Glasgow graveyards.

National mortality rates: the impact of inequality?

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.

Socio-economic differences in mortality among children. Do they persist into adulthood?

More than 1.2 million Swedish children born 1946–1960 and enumerated in the 1960 population census were followed up with respect to mortality for the period 1961–1979. Thus the children were younger than 15 years at the start of the follow-up and their age of death varied between 1 and 33 years. More than 13,000 deaths were analysed. The purpose was to examine whether or not mortality differences by socio-economic group in childhood persist into adulthood. Mortality differences by childhood socio-economic group were studied for both children/adolescents (1–19 years old) and young adults (20–33 years old). Information about the adults' own occupational status was not available. Therefore, to allow a deeper analysis, another group of adults, whose mortality could be analysed by their own socio-economic group, was used as a comparison group. Among children and adolescents there was a clear socio-economic group difference in mortality. Children in families of non-manual workers had a significantly lower mortality than children in the families of manual workers. In particular this was the case for boys. Socio-economic differences in total mortality are evident also in the age between 20 and 33 years among men but it could not be demonstrated here that these are a result of childhood socio-economic group rather than achieved socio-economic group. However, the study indicates that some differences in childhood, to a certain degree and for some diagnoses, may persist into adulthood. Of particular interest may be a tendency for cardiovascular disease mortality to be elevated among sons and daughters of manual workers. We conclude that this question is worth further attention.

La croissance démographique de l'Afrique. Bilan et perspectives

Despite great improvements over the past several years, the quality of demographic data in Africa is still a problem, and Africa remains the least well known continent. Population growth is extremely rapid, with all countries growing at annual rates of over 3%. The natural increase rate even shows some signs of increasing slightly in the next decade or so. Africa's population was estimated at 220 million in 1950, 650 million at present, and is projected at 1.5 billion by 2025. Africans represented 9% of the world population in 1960, but will increase to 19% around 2025. The rapid population growth is the result of declining mortality since the 1950s unmatched by changes in fertility. There are significant socioeconomic and rural-urban mortality differentials in Africa, but as yet only highly educated urbanites have measurably reduced their family size. 2 consequences of this rapid growth are the youth of the population, with almost 50% under 20 years, and its high density in some areas. By 2025, 18 countries will have densities of over 100 persons per sq km. Almost everywhere in Africa, family sizes are at least 6 children/woman. 3 factors explaining this high level of fertility are the earliness and universality of marriage, rates of contraceptive usage of only 4-10% in most countries, and declining durations of breast feeding and sexual abstinence, which traditionally served as brakes on fertility. As a rule, women marry young and remain married until the end of their reproductive years. Divorce and widowhood are common, but remarriage is usually rapid if the woman is still of reproductive age. Life expectancy at birth in sub-Saharan Africa has increased from some 36 years around 1950 to 50 years at present. Progress in control of mortality, and especially infant mortality, has been slower than expected, and Africa still has by far the lowest life expectancy of any major region. Regional, rural-urban, and socioeconomic mortality differentials are considerable and sometimes increasing. In some countries the gaps in life expectancy between rural and urban residents or between social classes are as high as 15 or 20 years. The major causes of death have scarcely changed in 2 or 3 decades: diarrhea, measles, acute respiratory infections, tetanus, malaria, all aggravated by malnutrition and the new scourge of AIDS. Migration and urbanization remain major components of family survival strategies. The increasing pace of urbanization has brought a decline in urban living standards. About half of the world's refugees and displaced persons are in Africa. It was not its demography that brought Africa to its current position of underdevelopment, but population will exercise enormous pressure on available resources. Already for the continents as a whole, food production is increasing less rapidly than population. The challenges are immense: from now until 2000, the working age population will increase by 49% and the school age population (6-11 years) by 58%.