Feikje Groenhof

Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies

Abstract Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causes of death and to assess the contributions these causes make to class differences in total mortality. Design: Comparison of cause of death in manual and non-manual classes, using data on mortality from national studies. Setting: Eleven western European countries in the period 1980-9. Subjects: Men aged 45–59 years at death. Results: A north-south gradient was observed: mortality from ischaemic heart disease was strongly related to occupational class in England and Wales, Ireland, Finland, Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean countries. In the latter countries, cancers other than lung cancer and gastrointestinal diseases made a large contribution to class differences in total mortality. Inequalities in lung cancer, cerebrovascular disease, and external causes of death also varied greatly between countries. Conclusions: These variations in cause specific mortality indicate large differences between countries in the contribution that disease specific risk factors like smoking and alcohol consumption make to socioeconomic inequalities in mortality. The mortality advantage of people in higher occupational classes is independent of the precise diseases and risk factors involved. Key messages Socioeconomic inequalities in total mortality among middle aged men are about equally large in most western European countries, with the exception of larger inequalities in France and Finland Inequalities in mortality from specific causes of death, and the contributions these causes make to inequalities in total mortality, vary between countries The contribution to inequalities in mortality of disease specific risk factors like smoking and alcohol consumption varies greatly between countries This variability imposes limits on the exchange of research findings and experiences with health policies between western European countries The similar size of inequalities in total mortality in most countries underlines the generalised ability of higher occupational classes to better avoid premature death

Socioeconomic inequalities in mortality among women and among men: an international study

OBJECTIVES This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.

Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

OBJECTIVES Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.

Mortality by occupational class among men 30-64 years in 11 European countries

This study compares eleven countries with respect to the magnitude of mortality differences by occupational class, paying particular attention to problems with the reliability and comparability of the data that are available for different countries. Nationally representative data on mortality by occupational class among men 30-64 years at death were obtained from longitudinal and cross-sectional studies. A common social class scheme was applied to most data sets. The magnitude of mortality differences was quantified by three summary indices. Three major data problems were identified and their potential effect on inequality estimates was quantified for each country individually. For men 45-59 years, the mortality rate ratio comparing manual classes to non-manual classes was about equally large for four Nordic countries, England and Wales, Ireland, Switzerland, Italy, Spain and Portugal. Relatively large ratios were only observed for France. The same applied to men 60 64 years (data for only 5 countries, including France). For men 30-44 years, there was evidence for smaller mortality differences in Italy and larger differences in Norway, Sweden and especially Finland (no data for France and Spain). Application of other summary indices to men 45-59 years showed slightly different patterns. When the population distribution over occupational classes was taken into account, relatively small differences were observed for Switzerland, Italy and Spain. When national mortality levels were taken into account, relatively large differences were observed for Finland and Ireland. For each summary index, however, France leads the international league table. Data problems were found to have the potential to bias inequality estimates, substantially especially those for Ireland, Spain and Portugal. This study underlines the similarities rather than the dissimilarities between European countries. There is no evidence that mortality differences are smaller in countries with more egalitarian socio-economic and other policies.

Socioeconomic Inequalities in Stroke Mortality Among Middle-Aged Men An International Overview

BACKGROUND AND PURPOSE Several studies observed that people from lower socioeconomic groups have higher chances of dying of stroke. There are reasons to expect that these differences are relatively small in southern European countries or in Nordic welfare states. This report therefore presents an international overview of socioeconomic differences in stroke mortality. METHODS Unpublished data on mortality by occupational class were obtained from national longitudinal studies or cross-sectional studies. The data refer to deaths among men aged 30 to 64 years in the 1980s. A common occupational class scheme was applied to most countries. The mortality difference between manual classes and nonmanual classes was measured in relative terms (by rate ratios) and in absolute terms (by rate differences). RESULTS In all countries, manual classes had higher stroke mortality rates than nonmanual classes. This difference was relatively large in England and Wales, Ireland, and Finland and relatively small in Sweden, Norway, Denmark, Italy, and Spain. Differences were intermediate in the United States, France, and Switzerland. In Portugal, mortality differences were intermediate in relative terms but large in absolute terms. In most countries, inequalities were much larger for stroke mortality than for ischemic heart disease mortality. CONCLUSIONS Socioeconomic differences in stroke mortality are a problem common to all countries studied. There are probably large variations, however, in the contribution that different risk factors, such as tobacco and alcohol consumption, make to the stroke mortality excess of lower socioeconomic groups. Medical services can contribute to reducing socioeconomic differences in stroke mortality.

Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health

Abstract Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causes of death and to assess the contributions these causes make to class differences in total mortality. Design: Comparison of cause of death in manual and non-manual classes, using data on mortality from national studies. Setting: Eleven western European countries in the period 1980-9. Subjects: Men aged 45–59 years at death. Results: A north-south gradient was observed: mortality from ischaemic heart disease was strongly related to occupational class in England and Wales, Ireland, Finland, Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean countries. In the latter countries, cancers other than lung cancer and gastrointestinal diseases made a large contribution to class differences in total mortality. Inequalities in lung cancer, cerebrovascular disease, and external causes of death also varied greatly between countries. Conclusions: These variations in cause specific mortality indicate large differences between countries in the contribution that disease specific risk factors like smoking and alcohol consumption make to socioeconomic inequalities in mortality. The mortality advantage of people in higher occupational classes is independent of the precise diseases and risk factors involved. Key messages Socioeconomic inequalities in total mortality among middle aged men are about equally large in most western European countries, with the exception of larger inequalities in France and Finland Inequalities in mortality from specific causes of death, and the contributions these causes make to inequalities in total mortality, vary between countries The contribution to inequalities in mortality of disease specific risk factors like smoking and alcohol consumption varies greatly between countries This variability imposes limits on the exchange of research findings and experiences with health policies between western European countries The similar size of inequalities in total mortality in most countries underlines the generalised ability of higher occupational classes to better avoid premature death

The association between two windchill indices and daily mortality variation in The Netherlands

OBJECTIVES The purpose of this study was to compare temperature and two windchill indices with respect to the strength of their association with daily variation in mortality in the Netherlands during 1979 to 1987. The two windchill indices were those developed by Siple and Passel and by Steadman. METHODS Daily numbers of cause-specific deaths were related to the meteorological variables by means of Poisson regression with control for influenza incidence. Lag times were taken into account. RESULTS Daily variation in mortality, especially mortality from heart disease, was more strongly related to the Steadman windchill index than to temperature or the Siple and Passel index (34.9%, 31.2%, and 31.5%, respectively, of mortality variation explained). The strongest relation was found with daytime values of the Steadman index. CONCLUSIONS In areas where spells of cold are frequently accompanied by strong wind, the use of the Steadman index probably adds much to the identification of weather conditions involving an increased risk of death. The results of this study provide no justification for the wide-spread use (e.g., in the United States) of the Siple and Passel index.

Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studiesCommentary: Unequal inequalities across Europe

Abstract Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causes of death and to assess the contributions these causes make to class differences in total mortality. Design: Comparison of cause of death in manual and non-manual classes, using data on mortality from national studies. Setting: Eleven western European countries in the period 1980-9. Subjects: Men aged 45–59 years at death. Results: A north-south gradient was observed: mortality from ischaemic heart disease was strongly related to occupational class in England and Wales, Ireland, Finland, Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean countries. In the latter countries, cancers other than lung cancer and gastrointestinal diseases made a large contribution to class differences in total mortality. Inequalities in lung cancer, cerebrovascular disease, and external causes of death also varied greatly between countries. Conclusions: These variations in cause specific mortality indicate large differences between countries in the contribution that disease specific risk factors like smoking and alcohol consumption make to socioeconomic inequalities in mortality. The mortality advantage of people in higher occupational classes is independent of the precise diseases and risk factors involved. Key messages Socioeconomic inequalities in total mortality among middle aged men are about equally large in most western European countries, with the exception of larger inequalities in France and Finland Inequalities in mortality from specific causes of death, and the contributions these causes make to inequalities in total mortality, vary between countries The contribution to inequalities in mortality of disease specific risk factors like smoking and alcohol consumption varies greatly between countries This variability imposes limits on the exchange of research findings and experiences with health policies between western European countries The similar size of inequalities in total mortality in most countries underlines the generalised ability of higher occupational classes to better avoid premature death