title: Decreasing educational differences in mortality over 40 years: evidence from the Turin Longitudinal Study (Italy).
abstract: BACKGROUND
  Recent studies suggest that inequalities in premature mortality have continued to rise over the last decade in most European countries, but not in southern European countries.
  
  
  METHODS
  In this study, we assess long-term trends (1971-2011) in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a record-linkage study including all individuals resident in Turin in the 1971, 1981, 1991 and 2001 censuses, and aged 30-99 years (more than 2 million people). We examined mortality for all causes, cardiovascular disease (CVD), all cancers and specific cancers (lung, breast), as well as smoking and alcohol-related mortality.
  
  
  RESULTS
  Overall mortality substantially decreased in all educational groups over the study period, although cancer rates only slightly declined. Absolute inequalities decreased for both genders (SII=962/694 in men/women in 1972-1976 and SII=531/259 in 2007-2011, p<0.01). Among men, absolute inequalities for CVD and alcohol-related causes declined (p<0.05), while remaining stable for other causes of death. Among women, declines in absolute inequalities were observed for CVD, smoking and alcohol-related causes and lung cancer (p<0.05). Relative inequalities in all-cause mortality remained stable for men and decreased for women (RII=1.92/2.03 in men/women in 1972-1976 and RII=2.15/1.32 in 2007-2011). Among men, relative inequalities increased for smoking-related causes, while among women they decreased for all cancers, CVD, smoking-related causes and lung cancer (p<0.05).
  
  
  CONCLUSIONS
  Absolute inequalities in mortality strongly declined over the study period in both genders. Relative educational inequalities in mortality were generally stable among men; while they tended to narrow among women. In general, this study supports the hypothesis that educational inequalities in mortality have decreased in southern European countries.
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stringhini
authors.affiliation: Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Spadea
authors.affiliation: Public Health and Paediatric Sciences Department, University of Turin, Turin, Italy.
authors.forename: Morena
authors.initials: M
authors.lastname: Stroscia
authors.affiliation: Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Onorati
authors.affiliation: Department of Epidemiology and Environmental Health, Regional Environment Protection Agency, Grugliasco (TO), Italy.
authors.forename: Moreno
authors.initials: M
authors.lastname: Demaria
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Zengarini
authors.affiliation: Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death / Q000639:trends*; D003468:Cultural Evolution; D004522:Educational Status; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D009369:Neoplasms / Q000401:mortality; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality; D012959:Socioeconomic Factors
keywords: EPIDEMIOLOGY; MORTALITY; SOCIAL EPIDEMIOLOGY