title: Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations.
abstract: BACKGROUND
  Studies of socioeconomic disparities in patterns of cause of death have been limited to single countries, middle-aged people, men, or broad cause of death groups. We assessed contribution of specific causes of death to disparities in mortality between groups with different levels of education, in men and women, middle-aged and old, in eight western European populations.
  
  
  METHODS
  We analysed data from longitudinal mortality studies by cause of death, between Jan 1, 1990, and Dec 31, 1997. Data were included for more than 1 million deaths in 51 million person years of observation.
  
  
  RESULTS
  Absolute educational inequalities in total mortality peaked at 2127 deaths per 100000 person years in men, and at 1588 deaths per 100000 person years in women aged 75 years and older. In this age-group, rate ratios were greater than 1.00 for total mortality and all specific causes of death, apart form prostate cancer in men and lung cancer in women, showing increased mortality in low versus high educational groups. In men, cardiovascular diseases accounted for 39% of the difference between low and high educational groups in total mortality, cancer for 24%, other diseases for 32%, and external causes for 5%. Among women, contributions were 60%, 11%, 30%, and 0%, respectively. The contributions of cerebrovascular disease, other cardiovascular diseases, pneumonia, and COPD strongly increased by age, whereas those of cancer and external causes declined. Although relative inequalities in total mortality were closely similar in all populations, we noted striking differences in the contribution of specific causes to these inequalities.
  
  
  CONCLUSIONS
  Research needs to be broadened to include older populations, other diseases, and populations from different parts of Europe. Effective interventions should be developed and implemented to reduce exposure to cardiovascular risk factors in low-educational groups.
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Huisman
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.forename: Jens-Kristian
authors.initials: JK
authors.lastname: Borgan
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gadeyne
authors.forename: Myer
authors.initials: M
authors.lastname: Glickman
authors.forename: Chiara
authors.initials: C
authors.lastname: Marinacci
authors.forename: Christoph
authors.initials: C
authors.lastname: Minder
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: Tapani
authors.initials: T
authors.lastname: Valkonen
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000401:mortality; D012959:Socioeconomic Factors