Dataset Information

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

ABSTRACT:

Background

To more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden.

Methods

Data from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991-2002.

Results

The results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers.

Conclusion

CHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.

SUBMITTER: Rosvall M

PROVIDER: S-EPMC1513205 | biostudies-literature | 2006 Mar

REPOSITORIES: biostudies-literature

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Publications

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

Rosvall Maria M Chaix Basile B Lynch John J Lindström Martin M Merlo Juan J

BMC public health 20060328

<h4>Background</h4>To more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to soci ...[more]

PMID: 16569222

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Project description:Background and aimsWhen measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time.DesignCause-deleted life table analysis of national mortality records.SettingEngland and Wales, 2001-16.CasesAll-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD).MeasurementsLife expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'.FindingsIn 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.ConclusionsDeaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.

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Project description:AimsSleep disturbances exhibit a strong social patterning, and inadequate sleep has been associated with adverse health outcomes, including cardiovascular disorders (CVD). However, the contribution of sleep to socioeconomic inequalities in CVD is unclear. This study pools data from eight European cohorts to investigate the role of sleep duration in the association between life-course socioeconomic status (SES) and CVD.Methods and resultsWe used cross-sectional data from eight European cohorts, totalling 111 205 participants. Life-course SES was assessed using father's and adult occupational position. Self-reported sleep duration was categorized into recommended (6-8.5 h/night), long (>8.5 h/night), and short (<6 h/night). We examined two cardiovascular outcomes: coronary heart disease (CHD) and stroke. Main analyses were conducted using pooled data and examined the association between life-course SES and CVD, and the contribution of sleep duration to this gradient using counterfactual mediation. Low father's occupational position was associated with an increased risk of CHD (men: OR = 1.19, 95% CI [1.04; 1.37]; women: OR = 1.25, 95% CI [1.02; 1.54]), with marginal decrease of the gradient after accounting for adult occupational position (men: OR = 1.17, 95% CI [1.02; 1.35]; women: OR = 1.22, 95% CI [0.99; 1.52]), and no mediating effect by short sleep duration. Low adult occupational position was associated with an increased risk of CHD in both men and women (men: OR = 1.48, 95% CI [1.14; 1.92]; women: OR = 1.53, 95% CI [1.04; 2.21]). Short sleep duration meaningfully contributed to the association between adult occupational position and CHD in men, with 13.4% mediation. Stroke did not exhibit a social patterning with any of the variables examined.ConclusionThis study suggests that inadequate sleep accounts to a meaningful proportion of the association between adult occupational position and CHD, at least in men. With sleep increasingly being considered an important cardiovascular risk factor in its own terms, our study additionally points to its potential role in social inequalities in cardiovascular disease.

Dataset Information

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

Background

Methods

Results

Conclusion

Publications

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

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