Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000.
BACKGROUND
Post-communist transition has had a huge impact on mortality in Eastern Europe. We examined how educational inequalities in mortality changed between 1990 and 2000 in Estonia, Lithuania, Poland and Hungary.


METHODS
Cross-sectional data for the years around 1990 and 2000 were used. Age-standardized mortality rates and mortality rate ratios (for total mortality only) were calculated for men and women aged 35-64 in three educational categories, for five broad cause-of-death groups and for five (seven among women) specific causes of death.


RESULTS
Educational inequalities in mortality increased in all four countries but in two completely different ways. In Poland and Hungary, mortality rates decreased or remained the same in all educational groups. In Estonia and Lithuania, mortality rates decreased among the highly educated, but increased among those of low education. In Estonia and Lithuania, for men and women combined, external causes and circulatory diseases contributed most to the increasing educational gap in total mortality.


CONCLUSIONS
Different trends were observed between the two former Soviet republics and the two Central Eastern European countries. This divergence can be related to differences in socioeconomic development during the 1990s and in particular, to the spread of poverty, deprivation and marginalization. Alcohol and psychosocial stress may also have been important mediating factors.
Leinsalu
Mall
M
Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University, Huddinge, Sweden. mall.leinsalu@sh.se
Stirbu
Irina
I
Vågerö
Denny
D
Kalediene
Ramune
R
Kovács
Katalin
K
Wojtyniak
Bogdan
B
Wróblewska
Wiktoria
W
Mackenbach
Johan P
JP
Kunst
Anton E
AE
D000328:Adult; D003148:Communism; D003430:Cross-Sectional Studies; D004522:Educational Status; D004957:Estonia / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011044:Poland / Q000453:epidemiology; D012737:Sex Factors; D012922:Social Change