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

BMJ 1998;316:1636-1642 ( 30 May )

Papers

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

Editorial by Donnan

Anton E Kunst, assistant professor, Feikje Groenhof, researcher, Johan P Mackenbach, professor, EU Working Group on Socioeconomic Inequalities in Health.

Department of Public Health, Erasmus University, PO Box 1738, NL-3000 DR Rotterdam, Netherlands

Correspondence to: Dr Kunst kunst{at}mgz.fgg.eur.nl

Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causesof death and to assess the contributions these causes make toclass 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 occupationalclass in England and Wales, Ireland, Finland, Sweden, Norway,and Denmark, but not in France, Switzerland, and Mediterraneancountries. In the latter countries, cancers other than lung cancerand gastrointestinal diseases made a large contribution to classdifferences in total mortality. Inequalities in lung cancer, cerebrovasculardisease, and external causes of death also varied greatly betweencountries.
Conclusions: These variations in cause specific mortality indicate large differences between countries in the contributionthat disease specific risk factors like smoking and alcohol consumptionmake to socioeconomic inequalities in mortality. The mortalityadvantage of people in higher occupational classes is independentof 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

© BMJ 1998

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study: Debbie A Lawlor, Maarike Harro, Niels Wedderkopp, Lars Bo Andersen, Luis B Sardinha, Chris J Riddoch, Angie S Page, Sigmund A Anderssen, Karsten Froberg, David Stansbie, and George Davey Smith
BMJ 2005 331: 183. [Abstract] [Full Text] [PDF]

Socioeconomic inequalities for specific diseases show north-south gradient in Europe
BMJ 1998 316: 0. [Full Text]

The health of adult Europe: Stuart Donnan
BMJ 1998 316: 1620-1621. [Extract] [Full Text]

This article has been cited by other articles:

Holland, P., Burstrom, B., Moller, I., Whitehead, M. (2009). Socioeconomic inequalities in the employment impact of ischaemic heart disease: a longitudinal record linkage study in Sweden. Scand J Public Health 37: 450-458 [Abstract]
Cullen, M. R. (2009). Invited Commentary: The Search for Preventable Causes of Cardiovascular Disease--Whither Work?. Am J Epidemiol 169: 1422-1425 [Abstract] [Full text]
Koga, T., Kamimura, T., Nishimura, M. (2009). How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?. ANN INTERN MED 150: 426-426 [Full text]
Menvielle, G., Boshuizen, H., Kunst, A. E., Dalton, S. O., Vineis, P., Bergmann, M. M., Hermann, S., Ferrari, P., Raaschou-Nielsen, O., Tjonneland, A., Kaaks, R., Linseisen, J., Kosti, M., Trichopoulou, A., Dilis, V., Palli, D., Krogh, V., Panico, S., Tumino, R., Buchner, F. L., van Gils, C. H., Peeters, P. H. M., Braaten, T., Gram, I. T., Lund, E., Rodriguez, L., Agudo, A., Sanchez, M.-J., Tormo, M.-J., Ardanaz, E., Manjer, J., Wirfalt, E., Hallmans, G., Rasmuson, T., Bingham, S., Khaw, K.-T., Allen, N., Key, T., Boffetta, P., Duell, E. J., Slimani, N., Gallo, V., Riboli, E., Bueno-de-Mesquita, H. B. (2009). The Role of Smoking and Diet in Explaining Educational Inequalities in Lung Cancer Incidence. JNCI J Natl Cancer Inst 101: 321-330 [Abstract] [Full text]
Al-Delaimy, W. K (2008). Commentary: Lactose and ischaemic heart disease: a weak 28-year-old hypothesis. Int J Epidemiol 37: 1214-1216 [Full text]
Erikson, R., Torssander, J. (2008). Social class and cause of death. Eur J Public Health 18: 473-478 [Abstract] [Full text]
De Vogli, R., Gimeno, D., Kivimaki, M., Mackenbach, J. P., Stirbu, I., Kunst, A. E. (2008). Socioeconomic Inequalities in Health in 22 European Countries. NEJM 359: 1290-1291 [Full text]
White, S. L., McGeechan, K., Jones, M., Cass, A., Chadban, S. J., Polkinghorne, K. R., Perkovic, V., Roderick, P. J. (2008). Socioeconomic Disadvantage and Kidney Disease in the United States, Australia, and Thailand. Am. J. Public Health 98: 1306-1313 [Abstract] [Full text]
Mackenbach, J. P., Stirbu, I., Roskam, A.-J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., Kunst, A. E., the European Union Working Group on Socioeconomic, (2008). Socioeconomic Inequalities in Health in 22 European Countries. NEJM 358: 2468-2481 [Abstract] [Full text]
Darmon, N., Drewnowski, A. (2008). Does social class predict diet quality?. Am. J. Clin. Nutr. 87: 1107-1117 [Abstract] [Full text]
Arendt, J. N., Lauridsen, J. (2008). Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?. Eur J Public Health 18: 131-137 [Abstract] [Full text]
Harald, K, Koskinen, S, Jousilahti, P, Torppa, J, Vartiainen, E, Salomaa, V (2008). Changes in traditional risk factors no longer explain time trends in cardiovascular mortality and its socioeconomic differences. J. Epidemiol. Community Health 62: 251-257 [Abstract] [Full text]
Rout, H. S. (2008). Socio-economic Factors and Household Health Expenditure: The Case of Orissa. Journal of Health Management 10: 101-118 [Abstract]
Menvielle, G., Leclerc, A., Chastang, J.-F., Melchior, M., Luce, D., for the Evolution Des Inegalites Sociales Par Caus, (2007). Changes in Socioeconomic Inequalities in Cancer Mortality Rates Among French Men Between 1968 and 1996. Am. J. Public Health 97: 2082-2087 [Abstract] [Full text]
Maki, N. E., Martikainen, P. T. (2007). Socioeconomic differences in suicide mortality by sex in Finland in 1971--2000: A register-based study of trends, levels, and life expectancy differences. Scand J Public Health 35: 387-395 [Abstract]
Laaksonen, E., Martikainen, P., Lahelma, E., Lallukka, T., Rahkonen, O., Head, J., Marmot, M. (2007). Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. Int J Epidemiol 36: 776-786 [Abstract] [Full text]
Rasmussen, J. N, Rasmussen, S., Gislason, G. H, Buch, P., Abildstrom, S. Z, Kober, L., Osler, M., Diderichsen, F., Torp-Pedersen, C., Madsen, M. (2006). Mortality after acute myocardial infarction according to income and education.. J. Epidemiol. Community Health 60: 351-356 [Abstract] [Full text]
Galobardes, B., Shaw, M., Lawlor, D. A, Lynch, J. W, Davey Smith, G. (2006). Indicators of socioeconomic position (part 2). J. Epidemiol. Community Health 60: 95-101 [Abstract] [Full text]
Starfield, B. (2006). State of the Art in Research on Equity in Health. Journal of Health Politics, Policy and Law 31: 11-32 [Abstract]
Braveman, P. A., Cubbin, C., Egerter, S., Chideya, S., Marchi, K. S., Metzler, M., Posner, S. (2005). Socioeconomic Status in Health Research: One Size Does Not Fit All. JAMA 294: 2879-2888 [Abstract] [Full text]
Batty, G. D. (2005). Re: Meat, Fish, and Colorectal Cancer Risk: The European Prospective Investigation into Cancer and Nutrition. JNCI J Natl Cancer Inst 97: 1787-1787 [Full text]
Nilsson, P. M., Nilsson, J.-A., Ostergren, P.-O., Berglund, G. (2005). Social mobility, marital status, and mortality risk in an adult life course perspective: The Malmo Preventive Project. Scand J Public Health 33: 412-423 [Abstract]
Nusselder, W. J., Looman, C. W.N., Mackenbach, J. P., Huisman, M., van Oyen, H., Deboosere, P., Gadeyne, S., Kunst, A. E. (2005). The Contribution of Specific Diseases to Educational Disparities in Disability-Free Life Expectancy. Am. J. Public Health 95: 2035-2041 [Abstract] [Full text]
Hemmingsson, T., Lundberg, I. (2005). Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility?. Eur J Public Health 15: 518-522 [Abstract] [Full text]
Phelan, J. C., Link, B. G. (2005). Controlling Disease and Creating Disparities: A Fundamental Cause Perspective. Journals of Gerontology Series B: Psychological Sciences and Social Science 60: S27-S33 [Abstract] [Full text]
Jackson, P. B. (2005). Health Inequalities Among Minority Populations. Journals of Gerontology Series B: Psychological Sciences and Social Science 60: S63-S67 [Abstract] [Full text]
Lawlor, D. A, Harro, M., Wedderkopp, N., Andersen, L. B., Sardinha, L. B, Riddoch, C. J, Page, A. S, Anderssen, S. A, Froberg, K., Stansbie, D., Davey Smith, G. (2005). Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study. BMJ 331: 183- [Abstract] [Full text]
Cheng, T Y, Wen, C P, Tsai, S P, Chung, W S I, Hsu, C C (2005). Reducing health disparity in Taiwan: quantifying the role of smoking. Tobacco Control 14: i23-i27 [Abstract] [Full text]
Yarnell, J, Yu, S, McCrum, E, Arveiler, D, Hass, B, Dallongeville, J, Montaye, M, Amouyel, P, Ferrieres, J, Ruidavets, J-B, Evans, A, Bingham, A, Ducimetiere, P, for the PRIME study group, (2005). Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: the PRIME Study. Int J Epidemiol 34: 268-275 [Abstract] [Full text]
Hemmingsson, T., Lundberg, I. (2005). How far are socioeconomic differences in coronary heart disease hospitalization, all-cause mortality and cardiovascular mortality among adult Swedish males attributable to negative childhood circumstances and behaviour in adolescence?. Int J Epidemiol 34: 260-267 [Abstract] [Full text]
Silventoinen, K., Pankow, J., Jousilahti, P., Hu, G., Tuomilehto, J. (2005). Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women. Int J Epidemiol 34: 327-334 [Abstract] [Full text]
Power, C., Graham, H., Due, P., Hallqvist, J., Joung, I., Kuh, D., Lynch, J. (2005). The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison. Int J Epidemiol 34: 335-344 [Abstract] [Full text]
Dalstra, J., Kunst, A., Borrell, C, Breeze, E, Cambois, E, Costa, G, Geurts, J., Lahelma, E, Van Oyen, H, Rasmussen, N., Regidor, E, Spadea, T, Mackenbach, J. (2005). Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 34: 316-326 [Abstract] [Full text]
Andersen, I, Burr, H, Kristensen, T S, Gamborg, M, Osler, M, Prescott, E, Diderichsen, F (2004). Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies. Occup. Environ. Med. 61: 886-892 [Abstract] [Full text]
Blakely, T., Kawachi, I., Atkinson, J., Fawcett, J. (2004). Income and mortality: the shape of the association and confounding New Zealand Census-Mortality Study, 1981-1999. Int J Epidemiol 33: 874-883 [Abstract] [Full text]
Galobardes, B., Lynch, J. W., Davey Smith, G. (2004). Childhood Socioeconomic Circumstances and Cause-specific Mortality in Adulthood: Systematic Review and Interpretation. Epidemiol Rev 26: 7-21 [Full text]
Vahtera, J, Pentti, J, Kivimaki, M (2004). Sickness absence as a predictor of mortality among male and female employees. J. Epidemiol. Community Health 58: 321-326 [Abstract] [Full text]
Makela, P, Keskimaki, I, Koskinen, S (2003). What underlies the high alcohol related mortality of the disadvantaged: high morbidity or poor survival?. J. Epidemiol. Community Health 57: 981-986 [Abstract] [Full text]
Langenberg, C, Hardy, R, Kuh, D, Brunner, E, Wadsworth, M (2003). Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort. J. Epidemiol. Community Health 57: 816-822 [Abstract] [Full text]
Mackenbach, J. P, Bos, V., Andersen, O., Cardano, M., Costa, G., Harding, S., Reid, A., Hemstrom, O., Valkonen, T., Kunst, A. E (2003). Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 32: 830-837 [Abstract] [Full text]
Brown, K. W., Levy, A. R., Rosberger, Z., Edgar, L. (2003). Psychological Distress and Cancer Survival: A Follow-Up 10 Years After Diagnosis. Psychosom. Med. 65: 636-643 [Abstract] [Full text]
Bopp, M., Minder, C. E (2003). Mortality by education in German speaking Switzerland, 1990-1997: results from the Swiss National Cohort. Int J Epidemiol 32: 346-354 [Abstract] [Full text]
Borrell, C., Cortes, I., Artazcoz, L., Molinero, E., Moncada, S. (2003). Social inequalities in mortality in a retrospective cohort of civil servants in Barcelona. Int J Epidemiol 32: 386-389 [Abstract] [Full text]
Braveman, P, Gruskin, S (2003). Defining equity in health. J. Epidemiol. Community Health 57: 254-258 [Abstract] [Full text]
Shohaimi, S, Luben, R, Wareham, N, Day, N, Bingham, S, Welch, A, Oakes, S, Khaw, K-T (2003). Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk). J. Epidemiol. Community Health 57: 270-276 [Abstract] [Full text]
Boyle, P., Golia, S., Daly, P., Johnston, P. G., Robertson, C. (2003). Cancer mortality in Ireland, 1926-1995. Ann Oncol 14: 323-332 [Abstract] [Full text]
Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., Ansseau, M. (2003). Socioeconomic Inequalities in Depression: A Meta-Analysis. Am J Epidemiol 157: 98-112 [Abstract] [Full text]
Mann, C J (2003). Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg. Med. J. 20: 54-60 [Abstract] [Full text]
Kristensen, T. S., Borg, V., Hannerz, H. (2002). Socioeconomic status and psychosocial work environment: results from a Danish national study. Scand J Public Health 30: 41-48 [Abstract]
Fuhrer, R., Shipley, M. J., Chastang, J. F., Schmaus, A., Niedhammer, I., Stansfeld, S. A., Goldberg, M., Marmot, M. G. (2002). Socioeconomic Position, Health, and Possible Explanations: A Tale of Two Cohorts. Am. J. Public Health 92: 1290-1294 [Abstract] [Full text]
Kapral, M. K., Wang, H., Mamdani, M., Tu, J. V., Boden-Albala, B., Sacco, R. L. (2002). Effect of Socioeconomic Status on Treatment and Mortality After Stroke * Editorial Comment. Stroke 33: 268-275 [Abstract] [Full text]
Andersen, A.-M. N. (2001). Commentary: Social inequalities in risk of stillbirth--the price of success?. Int J Epidemiol 30: 1301-1302 [Full text]
Martikainen, P., Ishizaki, M., Marmot, M. G, Nakagawa, H., Kagamimori, S. (2001). Socioeconomic differences in behavioural and biological risk factors: a comparison of a Japanese and an English cohort of employed men. Int J Epidemiol 30: 833-838 [Abstract] [Full text]
Johnston, G. M., Boyd, C. J., Joseph, P., MacIntyre, M. (2001). Variation in Delivery of Palliative Radiotherapy to Persons Dying of Cancer in Nova Scotia, 1994 to 1998. JCO 19: 3323-3332 [Abstract] [Full text]
Salomaa, V, Miettinen, H, Niemela, M, Ketonen, M, Mahonen, M, Immonen-Raiha, P, Lehto, S, Vuorenmaa, T, Koskinen, S, Palomaki, P, Mustaniemi, H, Kaarsalo, E, Arstila, M, Torppa, J, Kuulasmaa, K, Puska, P, Pyorala, K, Tuomilehto, J (2001). Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study. J. Epidemiol. Community Health 55: 475-482 [Abstract] [Full text]
Martikainen, P, Valkonen, T, Martelin, T (2001). Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95. J. Epidemiol. Community Health 55: 494-499 [Abstract] [Full text]
Benach, J, Yasui, Y, Borrell, C, Saez, M, Pasarin, M I (2001). Material deprivation and leading causes of death by gender: evidence from a nationwide small area study. J. Epidemiol. Community Health 55: 239-245 [Abstract] [Full text]
TenHoor, T., Mannino, D. M., Moss, M. (2001). Risk Factors for ARDS in the United States : Analysis of the 1993 National Mortality Followback Study. Chest 119: 1179-1184 [Abstract] [Full text]
Martikainen, P., Lahelma, E., Ripatti, S., Albanes, D., Virtamo, J. (2001). Educational differences in lung cancer mortality in male smokers. Int J Epidemiol 30: 264-267 [Abstract] [Full text]
Blane, D. (2001). Commentary: Socioeconomic health differentials. Int J Epidemiol 30: 292-293 [Full text]
DER, G., WILKINSON, R., LYNCH, J., DUE, P., MUNTANER, C., SMITH, G. D. (2001). Absolute income and life expectancy. J. Epidemiol. Community Health 55: 151-151 [Full text]
SUSSER, M. (2000). The technological paradox of health inequality, and a probe with a practical tool. J. Epidemiol. Community Health 54: 882-883 [Full text]
Bartley, M, Fitzpatrick, R, Firth, D, Marmot, M (2000). Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993. J. Epidemiol. Community Health 54: 806-814 [Abstract] [Full text]
Salomaa, V., Niemela, M., Miettinen, H., Ketonen, M., Immonen-Raiha, P., Koskinen, S., Mahonen, M., Lehto, S., Vuorenmaa, T., Palomaki, P., Mustaniemi, H., Kaarsalo, E., Arstila, M., Torppa, J., Kuulasmaa, K., Puska, P., Pyorala, K., Tuomilehto, J. (2000). Relationship of Socioeconomic Status to the Incidence and Prehospital, 28-Day, and 1-Year Mortality Rates of Acute Coronary Events in the FINMONICA Myocardial Infarction Register Study. Circulation 101: 1913-1918 [Abstract] [Full text]
Cavelaars, A E J M, Kunst, A E, Geurts, J J M, Crialesi, R, Grötvedt, L, Helmert, U, Lahelma, E, Lundberg, O, Matheson, J, Mielck, A, Rasmussen, N K., Regidor, E, Rosário-Giraldes, M d., Spuhler, T., Mackenbach, J P (2000). Educational differences in smoking: international comparison. BMJ 320: 1102-1107 [Abstract] [Full text]
Martikainen, P. T, Marmot, M. G (1999). Socioeconomic differences in weight gain and determinants and consequences of coronary risk factors. Am. J. Clin. Nutr. 69: 719-726 [Abstract] [Full text]
Acheson, D., Baker, D., Illsley, R. (1998). Inequalities in health. BMJ 317: 1659-1659 [Full text]
Kunst, A. E., del Rios, M., Groenhof, F., Mackenbach, J. P. (1998). Socioeconomic Inequalities in Stroke Mortality Among Middle-Aged Men : An International Overview. Stroke 29: 2285-2291 [Abstract] [Full text]