title: Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.
abstract: OBJECTIVE
  Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia.
  
  
  METHODS
  Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality.
  
  
  RESULTS
  Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality.
  
  
  CONCLUSIONS
  Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands; Faculty of Medicine, Universidad CES, Calle 10A #22-04, Medellin, Colombia. Electronic address: i.arroyavezuluaga@erasmusmc.nl.
authors.forename: Ivan
authors.initials: I
authors.lastname: Arroyave
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands. Electronic address: a.burdorf@erasmusmc.nl.
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
authors.affiliation: Faculty of Medicine, Universidad CES, Calle 10A #22-04, Medellin, Colombia. Electronic address: dcardona@ces.edu.co.
authors.forename: Doris
authors.initials: D
authors.lastname: Cardona
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands; London School of Economics and Political Science, LSE Health and Social Care, Cowdray House, Houghton Street, London WC2A 2AE, UK; Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address: M.Avendano-Pabon@lse.ac.uk.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendano
mesh_terms: D000328:Adult; D017677:Age Distribution; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease / Q000191:economics / Q000401:mortality*; D003105:Colombia / Q000453:epidemiology; D003141:Communicable Diseases / Q000191:economics / Q000401:mortality*; D017281:Cost of Illness; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D019456:Health Transition; D006708:Homicide / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D016012:Poisson Distribution; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014754:Violence / Q000191:economics / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality*
keywords: Age-specific death rate; Burden of illness; Colombia; Educational status; Health status disparities; Health transition; Mortality determinants; Socioeconomic factors