title: What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark? A nationwide register-based study.
abstract: OBJECTIVE
  The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009.
  
  
  METHODS
  A nationwide register-based study.
  
  
  METHODS
  Denmark.
  
  
  METHODS
  The whole Danish population aged 30 years or more in the period 1985-2009.
  
  
  METHODS
  The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct contribution from smoking and alcohol use on the absolute difference in mortality rates. The secondary outcome is life expectancy in relation to educational attainments.
  
  
  RESULTS
  Since 1985, Danish overall mortality rates have decreased. Alongside the improvement in mortality, the absolute difference in the mortality rate (per 100,000 persons) between the lowest and the highest educated quartile grew from 465 to 611 among men and from 250 to 386 among women. Smoking and alcohol use have caused 75% of the increase among men and 97% of the increase among women. Among men the increase was mainly caused by alcohol. In women the increase was mainly caused by smoking.
  
  
  CONCLUSIONS
  The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use are targeted to the lower educated part of the Danish population.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Mette Bjerrum
authors.initials: MB
authors.lastname: Koch
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Grønbæk
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Knud
authors.initials: K
authors.lastname: Juel
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D012959:Socioeconomic Factors
keywords: EPIDEMIOLOGY; PUBLIC HEALTH