Studies of specific causes of death should use household criteria

Papers p 1303

Women are often excluded from studies of health inequalities. The justification given for this is lack of data, but there is also a belief that health inequalities are a smaller problem for women than men. An additional problem is that it is more difficult and controversial to classify women by social class or by general standing in the community.1^–3

In this week's BMJ Sacker and colleagues show that using a particular indicator of social class or of social standing in the community influences the size of health inequalities (p 1303).4 They show that for women the mortality ratio comparing the bottom and the top groups in a seven step social scale is 1.75 when the Cambridge scale of occupations is used. In contrast the same ratio for women is only 1.52 with the categories in the new Office for National Statistics (ONS) socioeconomic classification. For men the contrast between top and bottom groups was greater with the ONS classification than with the Cambridge scale.

Health inequalities among women are (at least) of the same size as among men when Cambridge scores are used; the ONS classification, however, indicates that health inequalities …