All-cause and cause-specific mortality of social assistance recipients in Norway: a register-based follow-up study.
OBJECTIVE
To investigate the mortality among social assistance recipients, who are among the most marginalized people in Norway. Cause-specific mortality was analysed in an attempt to explain the excess mortality. Previous research has suggested that social disadvantage leads to higher mortality from all causes, whereas others have found substantial variation when studying separate causes. The impact of the various causes will influence policy recommendations.


METHODS
Data were compiled through linking between Norwegian administrative records. The entire population born between 1935 and 1974 (2,297,621 people) was followed with respect to social assistance and death from 1993 to 2003. Cause-specific, age-standardized mortality rates for social assistance recipients and the rest of the population were calculated, and both the absolute (rate difference) and relative (rate ratio) rates were measured.


RESULTS
The rate ratio for total mortality was 3.1 for men and 2.5 for women for the comparison between social assistance recipients and the general population. The mortality among social assistance recipients was higher for all causes, but the magnitude differed considerably, depending on the cause. The rate ratio for men ranged from 1.2 for non-smoking-related cancer to 18.8 for alcohol- and drug-related causes. Alcohol-and drug-related and violent causes together contributed to half of the excess mortality for men and one-third for women.


CONCLUSIONS
The mortality of this socially disadvantaged group was considerably higher than that of the general population, and this difference reflected mainly drug-related causes.
Naper
Sille Ohrem
SO
Research Group for Inclusive Social Welfare Policies, Faculty of Social Sciences, Oslo University College, Oslo, Norway. sille.ohremnaper@sam.hio.no
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012140:Respiratory Tract Diseases / Q000401:mortality; D012307:Risk Factors; D012943:Social Security; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data; D035862:Vulnerable Populations