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

doi:10.1016/0277-9536(93)90403-Q

Social Science & Medicine

Volume 36, Issue 4, February 1993, Pages 409-418

https://doi.org/10.1016/0277-9536(93)90403-Q Get rights and content

Abstract

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.

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Cited by (103)

Measuring social inequalities in cause-specific mortality in France: Comparison between linked and unlinked approaches
2013, Revue d'Epidemiologie et de Sante Publique
Citation Excerpt :
In this context, certain studies have adopted pragmatic and approximative methodologies: application of the rule of three to determine the mortality differentials by cause [13] or use of unlinked data in France [9,34–36] as well as for international comparisons [37]. Despite the limits of these approaches [10,38], certain results enter the public debate with no precautions taken. In addition, since 1999, the reform of the civil status statistic by the National Institute of Statistics and Economic Studies (INSEE) has modified the rules for data collection and SOC coding.
Monitoring the time trends in socioeconomic inequalities in mortality by cause is a key public health issue. The aim of this study was to compare methods to measure social inequalities in cause-specific mortality in the French population aged 25–55 years. More specifically, it compares bias and precision related to the use of occupational class declared at the last census (linked data) to the one declared at the time of death on the death certificate (unlinked data).
We used a representative sample of 1% of the French population. Causes of death were obtained by direct linkage with the French national death registry. Occupational class was classified into eight categories. Taking professionals and managers as the reference, relative risks of mortality by cause and their 95% confidence intervals were estimated using Poisson models for the 1983–1989, 1991–1997, and 2000–2006 periods. The relative risks were calculated with both linked data and exhaustive unlinked data.
Over the 2000–2006 period, occupational classes declared at census and on the death certificate were consistent for half of the deaths. Relative risks for manual workers were found to be similar between the two approaches over the 1983–1989 and 1991–1997 periods, and higher for the unlinked approach over the 2000–2006 period. Over the latter period, the order and magnitude of relative risks varied similarly by occupational class and cause of death for both approaches. Confidence intervals obtained from linked data were wide.
Occupational class derived from the death certificate must be used with caution as a measure for epidemiological purposes and the available linked data do not allow accurate estimates of social inequalities in cause-specific mortality. Other solutions should be considered in order to improve the follow-up of social inequalities in mortality. This would require the collection of educational level on the death certificate or the linkage of the cause of death database with other exhaustive and informative databases.
Le suivi dans le temps des inégalités sociales de mortalité représente un enjeu de santé publique majeur. Cette étude propose de présenter les données disponibles permettant d’évaluer les différentiels socioéconomiques de mortalité par cause dans la population âgée de 25 à 55 ans en France. Plus spécifiquement, elle compare le biais et la précision inhérents à l’utilisation de la profession et catégorie socioprofessionnelle (PCS) déclarée lors du dernier recensement (méthode chaînée dans l’échantillon démographique permanent [EDP]) ou à l’état civil au moment du décès (approche non chaînée exhaustive).
L’EDP, un échantillon au centième de la population vivant en France, apparié aux causes médicales de décès a été utilisé pour l’approche chaînée. Les données exhaustives de mortalité par cause ont été utilisées pour l’approche non chaînée. Les PCS ont été classées en huit catégories. En prenant les cadres comme référence, des risques relatifs de mortalité par cause et leur intervalle de confiance à 95 % ont été calculés à l’aide de régressions de Poisson pour les périodes 1983–1989, 1991–1997 et 2000–2006. Ces calculs ont été faits sur la base de l’EDP et sur les données exhaustives non chaînées.
Sur la période 2000–2006, les PCS déclarées au précédent recensement et à l’état civil concordent pour la moitié des décès de l’EDP. Lorsque l’on compare les deux approches, les risques relatifs sont généralement plus élevés avec l’approche non chaînée, en particulier pour les employés. Les risques relatifs pour les ouvriers sont similaires selon les deux approches sur les périodes 1983–1989 et 1991–1997 et plus élevés pour l’approche non chaînée sur la période 2000–2006. Sur cette dernière période, l’ordre et l’amplitude des risques relatifs varient de façon similaire selon la PCS et la cause de décès pour les deux approches. Les intervalles de confiance obtenus à l’aide de l’approche chaînée sont larges.
La PCS déclarée à l’état civil au moment du décès nécessite des précautions importantes pour un usage en épidémiologie et les données de l’EDP ne permettent pas un suivi fin des inégalités sociales de mortalité. D’autres solutions sont envisageables comme le recueil du niveau d’étude à l’état civil ou l’appariement de la base de mortalité par cause de décès avec d’autres bases de données à vocation exhaustive.
Educational inequalities in cancer incidence and mortality in Lithuania: A record linkage study
2012, Cancer Epidemiology
Citation Excerpt :
The main advantage of this study concerns the usage of the census-linked data. This allowed to avoid well documented disadvantages of census-unlinked cross-sectional data such as numerator–denominator bias [17,20,21] and to produce more reliable estimates of cancer mortality and incidence differentials by education in Lithuania. In general, our results on mortality and incidence differences by education are in line with the available international literature.
The aim of this study is to describe associations between incidence and mortality by major cancer sites and education in Lithuania.
The study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 1 July 2001 and 31 December 2004. Education-specific incidence and mortality rate ratios were estimated by means of multivariate Poisson regression models.
We found both the positive and inverse educational gradients in cancer incidence and mortality. The risk of developing cancer (all sites) was lower among men and women with the lowest education, whereas cancer mortality was higher among lower educated men. The higher educational level was also associated with an increased risk of prostate cancer among men and an increased risk of breast cancer among women. However, prostate cancer mortality was the highest in the lowest education group, whereas breast cancer mortality among women did not show any statistically significant differences. Lower educated men had significantly higher incidence and mortality due to lung and stomach cancers. Strikingly high incidence and mortality due to cervix cancer was observed among women with secondary and lower than secondary education.
The results point to inequalities in early diagnosis and survival from cancer and failures ensuring equal access to medical care. Further more in-depth studies are needed in order to understand the nature and determinants of these inequalities.
The socioeconomic distribution of life expectancy and healthy life expectancy in Chile
2023, International Journal for Equity in Health
Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region
2022, BMJ Open
The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk—a systematic review and meta-analysis
2021, BMC Medicine
Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis
2021, Population Health Metrics

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Social Science & Medicine

Abstract

References (26)

On the measurement of inequalities in health

Soc. Sci. Med.

Socio-economic Differential Mortality in Industrialized Societies

Introduction

Occupational Mortality, Decennial suppl. 1979–1980, 1982–1983

Differential Mortality in the United States: A Study in Socioeconomic Epidemiology

France: Mortalite et Changement de Categorie Socio-professionelle, Socio-economic Differential Mortality in Industrialized Societies

Socio-economic differences in stillbirths and infant mortality in Finland

Yearbook of Population Research in Finland XXXVII

Social inequalities in mortality: The social environment

Living conditions in childhood and coronary heart disease in adulthood. A mortality and morbidity study in two areas of Finland

Longitudinal studies in Britain relevant to inequalities in health

Changes in mortality in urban Canada from 1971 to 1986

Health Reports, Statistics Canada

Cited by (103)

Measuring social inequalities in cause-specific mortality in France: Comparison between linked and unlinked approaches

Educational inequalities in cancer incidence and mortality in Lithuania: A record linkage study

The socioeconomic distribution of life expectancy and healthy life expectancy in Chile

Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region

The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk—a systematic review and meta-analysis

Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis