Changes in the social class gradient of cirrhosis mortality in England and Wales across the 20th century.
OBJECTIVE
To explore the nature of the social class gradient of cirrhosis mortality in England and Wales across the 20th century.


METHODS
Data on male cirrhosis mortality by social class were obtained from the Registrar General's Decennial Supplements for the years 1921-1991. Data for 1941 were not collected because of the second World War.


RESULTS
In 1921, cirrhosis mortality was substantially higher among the professional and managerial classes (I and II) than among the other social classes (III-V). This marked social class difference persisted until 1961 when the differences between the social classes were inconsistent. By 1991, the gradient had reversed and the lower social classes (IV and V) had the higher mortality. The excess mortality was greatest for social class V. The change in the mortality gradient is stark: in 1921social classes I and II had a cirrhosis mortality at least twice that of social classes IV and V, but by 1991 this ratio had reversed.


CONCLUSIONS
The reversal in the social class gradient of cirrhosis mortality indicates a major change in risk factor distribution across social classes. Differential changes in alcohol consumption are a possible explanation for this change, although the 1991 social class gradient in cirrhosis is inconsistent with alcohol consumption data from national surveys. Further research is required to clarify the explanation for the observed gradient, so that appropriate preventive measures can be put into place.
Department of Public Health, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.i.k.crombie@chs.dundee.ac.uk
Iain K
IK
Crombie
Elaine
E
Precious
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000266:history / Q000378:metabolism / Q000401:mortality / Q000639:trends*; D004739:England; D000431:Ethanol / Q000378:metabolism; D049673:History, 20th Century; D006801:Humans; D008103:Liver Cirrhosis / Q000266:history / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification; D012307:Risk Factors; D012923:Social Class; D014852:Wales; D055815:Young Adult
D000431:Ethanol