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

Rosvall, Maria LU ; Chaix, Basile LU ; Lynch, J ; Lindström, Martin LU and Merlo, Juan LU orcid (2006) In BMC Public Health 6(79).
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 Skane) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position... (More)
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 Skane) 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. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMC Public Health
volume
6
issue
79
publisher
BioMed Central (BMC)
external identifiers
  • wos:000239432600001
  • scopus:33746256440
  • pmid:16569222
ISSN
1471-2458
DOI
10.1186/1471-2458-6-79
language
English
LU publication?
yes
id
9af5591c-138d-4eac-933b-305b2c866f5f (old id 1137207)
date added to LUP
2016-04-01 15:42:50
date last changed
2021-04-06 03:00:42
@article{9af5591c-138d-4eac-933b-305b2c866f5f,
  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 Skane) 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.},
  author       = {Rosvall, Maria and Chaix, Basile and Lynch, J and Lindström, Martin and Merlo, Juan},
  issn         = {1471-2458},
  language     = {eng},
  number       = {79},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Public Health},
  title        = {Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden},
  url          = {http://dx.doi.org/10.1186/1471-2458-6-79},
  doi          = {10.1186/1471-2458-6-79},
  volume       = {6},
  year         = {2006},
}