title: 'Fundamental causes' of inequalities in mortality: an empirical test of the theory in 20 European populations.
abstract: The 'fundamental causes' theory stipulates that when new opportunities for lowering mortality arise, higher socioeconomic groups will benefit more because of their greater material and non-material resources. We tested this theory using harmonised mortality data by educational level for 22 causes of death and 20 European populations from the period 1980-2010. Across all causes and populations, mortality on average declined by 2.49 per cent (95%CI: 2.04-2.92), 1.83% (1.37-2.30) and 1.34% (0.89-1.78) per annum among the high, mid and low educated, respectively. In 69 per cent of cases of declining mortality, mortality declined faster among the high than among the low educated. However, when mortality increased, less increase among the high educated was found in only 46 per cent of cases. Faster mortality decline among the high educated was more manifest for causes of death amenable to intervention than for non-amenable causes. The difference in mortality decline between education groups was not larger when income inequalities were greater. While our results provide support for the fundamental causes theory, our results suggest that other mechanisms than the theory implies also play a role.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Caspar W N
authors.initials: CWN
authors.lastname: Looman
authors.affiliation: Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Artnik
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Department of Sociology, Vrije Universiteit Brussel, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.affiliation: School of Geosciences, University of Edinburgh, Edinburgh.
authors.forename: Chris
authors.initials: C
authors.lastname: Dibben
authors.affiliation: Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Ramune
authors.initials: R
authors.lastname: Kalediene
authors.affiliation: Demographic Research Institute of the Central Statistical Office, Budapest, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Kovács
authors.affiliation: Stockholm Centre for Health and Social Change, Stockholm, Sweden.|Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
authors.forename: Mall
authors.initials: M
authors.lastname: Leinsalu
authors.affiliation: Department of Sociology, University of Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.affiliation: Department of Demography and Geodemography, Faculty of Science, Charles University in Prague, Prague, Czech Republic.
authors.forename: Jitka
authors.initials: J
authors.lastname: Rychtaříková
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: de Gelder
mesh_terms: D000328:Adult; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends*; D012959:Socioeconomic Factors
keywords: Europe; cause of death; fundamental causes theory; health inequalities; mortality; multilevel regression; trends