Sex differences in child and adolescent mortality by parental education in the Nordic countries.
BACKGROUND
Socioeconomic position inequalities in infant mortality are well known, but there is less information on how child mortality is socially patterned by sex and age.


OBJECTIVE
To assess maternal and paternal socioeconomic inequalities in mortality by sex, whether these differences vary by age and country, and how much of the sex differences can be explained by external causes of death.


METHODS
Data on all live-born children were received from national birth registries for 1981-2000 (Denmark: n=1,184,926; Norway: n=1,090,127; and Sweden n=1,961,911) and for 1987-2000 (Finland: n=841,470). Data on the highest level of education in 2000 were obtained from national education registers, and data on mortality and causes of death were received from the national cause-of-death registers until the end of follow-up (20 years or 2003).


RESULTS
Boys had a higher child and adolescent mortality than girls. The children of mothers and fathers who had had the shortest education time had the highest mortality for both sexes and for all ages and countries. The differences between the groups with longer than basic education were smaller, particularly among older children and girls. The gradient in mortality was mostly similar for boys and girls. Among 1-19-year-olds, 32% of boys' deaths and 27% of girls' deaths were due to external causes.


CONCLUSIONS
Boys' excess mortality was only partly explained by educational inequalities or by deaths from external causes. A more detailed analysis is needed to study whether the share of avoidable deaths is higher among children whose parents have had a shorter education time.
National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. mika.gissler@thl.fi
Mika
M
Gissler
Ossi
O
Rahkonen
Laust
L
Mortensen
Annett
A
Arntzen
Sven
S
Cnattingius
Anne-Marie
AM
Nybo Andersen
Elina
E
Hemminki
D000293:Adolescent; D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D046688:Child Mortality / Q000639:trends*; D016001:Confidence Intervals; D003718:Denmark; D004522:Educational Status; D005260:Female; D005387:Finland; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009664:Norway; D016487:Parenting / Q000523:psychology*; D012042:Registries / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013548:Sweden; D055815:Young Adult