Educational level and stroke mortality: a comparison of 10 European populations during the 1990s.
OBJECTIVE
Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged >or=30 years in 10 European populations during the 1990s.


METHODS
Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy.


RESULTS
Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women.


CONCLUSIONS
Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.
Avendaño
Mauricio
M
Department of Public Health, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, Netherlands. m.avendanopabon@erasmusmc.nl
Kunst
Anton E
AE
Huisman
Martijn
M
van Lenthe
Frank
F
Bopp
Matthias
M
Borrell
Carme
C
Valkonen
Tapani
T
Regidor
Enrique
E
Costa
Giuseppe
G
Donkin
Angela
A
Borgan
Jens-Kristian
JK
Deboosere
Patrick
P
Gadeyne
Sylvie
S
Spadea
Teresa
T
Andersen
Otto
O
Mackenbach
Johan P
JP
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries / Q000706:statistics & numerical data; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality*