Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men.
OBJECTIVE
To examine whether social inequalities in all-cause and coronary heart disease (CHD) mortality in Britain have reduced between 1978 and 2005.


METHODS
A prospective study of a socioeconomically representative population.


METHODS
24 British towns.


METHODS
7735 Men, aged 40-59 years at recruitment in 1978-1980 and followed up until 2005 through the National Health Service Central Register (164 120 person-years).


METHODS
Relative hazards and absolute risk differences for all-cause and CHD death comparing manual with non-manual social classes, calculated for different calendar periods.


RESULTS
3009 Deaths from all causes (1003 from CHD) occurred during follow-up. The overall hazard ratio (manual versus non-manual) was 1.56 (95% CI 1.45 to 1.69, p<0.001) for all-cause mortality and 1.54 (95% CI 1.35 to 1.76, p<0.001) for CHD mortality. The relative difference between these social groups tended to increase over time. The overall relative increase in hazard ratio comparing manual with non-manual groups over a 20-year calendar period was 1.22 (95% CI 0.83 to 1.80, p = 0.31) for all-cause mortality and 1.75 (95% CI 0.89 to 3.45, p = 0.11) for CHD mortality. The absolute difference in probability of survival to age 65 years between non-manual and manual groups fell from 29% in 1981 to 19% in 2001 for all-cause mortality and from 17% to 7% for CHD mortality.


CONCLUSIONS
Relative differences in all-cause and CHD mortality between manual and non-manual social class groups persisted and may have increased during this period. Absolute differences in mortality between these social groups decreased as a result of falling overall mortality rates. Greater effort is needed to reduce social inequalities in all-cause and CHD mortality in the new millennium.
Ramsay
S E
SE
Department of Primary Care and Population Sciences, Royal Free Hospital and University College Medical School, London, UK. s.ramsay@pcps.ucl.ac.uk
Morris
R W
RW
Lennon
L T
LT
Wannamethee
S G
SG
Whincup
P H
PH
D000328:Adult; D000367:Age Factors; D003327:Coronary Disease / Q000401:mortality; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012923:Social Class; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology