Educational inequalities in tuberculosis mortality in sixteen European populations.
OBJECTIVE
To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries.


METHODS
Data were obtained from the Eurothine Project, covering 16 populations between  1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities.


RESULTS
The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males.  Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and  in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations.


CONCLUSIONS
Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in  the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. joseluis.alvarez@urjc.es
J L
JL
Álvarez
A E
AE
Kunst
M
M
Leinsalu
M
M
Bopp
B H
BH
Strand
G
G
Menvielle
O
O
Lundberg
P
P
Martikainen
P
P
Deboosere
R
R
Kalediene
B
B
Artnik
J P
JP
Mackenbach
J H
JH
Richardus
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D014376:Tuberculosis / Q000401:mortality*; D014504:Urban Health / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*