Social inequalities in mortality by cause among men and women in France.
BACKGROUND
The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s.


METHODS
Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered.


RESULTS
Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases.


CONCLUSIONS
This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.
Saurel-Cubizolles
M-J
MJ
INSERM U149-IFR 69, 16 avenue Paul Vaillant Couturier, 94807 Villejuif cedex, France. saurel@vjf.inserm.fr
Chastang
J-F
JF
Menvielle
G
G
Leclerc
A
A
Luce
D
D
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D005602:France / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors