Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study.
OBJECTIVE
While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years.


METHODS
Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, and sudden death.


RESULTS
Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership.


CONCLUSIONS
Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed.
School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Ein Karem, Jerusalem, Israel. om@cc.huji.ac.il
Orly
O
Manor
Zvi
Z
Eisenbach
Yechiel
Y
Friedlander
Jeremy D
JD
Kark
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D004522:Educational Status; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors