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Nolasco A, Moncho J, Quesada JA, Melchor I, Pereyra-Zamora P, Tamayo-Fonseca N, Martínez-Beneito MA, Zurriaga O, Ballesta M, Daponte A, Gandarillas A, Domínguez-Berjón MF, Marí-Dell'Olmo M, Gotsens M, Izco N, Moreno MC, Sáez M, Martos C, Sánchez-Villegas P, Borrell C. Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project). Int J Equity Health 2015; 14:33. [PMID: 25879739 PMCID: PMC4392789 DOI: 10.1186/s12939-015-0164-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
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Affiliation(s)
- Andreu Nolasco
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Joaquin Moncho
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Jose Antonio Quesada
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Inmaculada Melchor
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España. .,Registro de Mortalidad de la Comunidad Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Plaza de España 6, 03010, Alicante, España.
| | - Pamela Pereyra-Zamora
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Nayara Tamayo-Fonseca
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Miguel Angel Martínez-Beneito
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Oscar Zurriaga
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Mónica Ballesta
- Department of Epidemiology, Regional Health Council, Murcia, Spain.
| | - Antonio Daponte
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Ana Gandarillas
- Servicio de Epidemiología. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - Marc Marí-Dell'Olmo
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Natividad Izco
- Dirección General de Salud Pública y Consumo, Gobierno de La Rioja, Calle Vara de Rey n° 8, 1ª planta, 26071, Logroño, España.
| | - M Concepción Moreno
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto de Salud Pública y Laboral de Navarra, C/ Leyre, 15, 31003, Pamplona, Navarra, Spain.
| | - Marc Sáez
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Grupo de Investigación en Estadística, Econometría y Salud (GRECS), [Research Group on Statistics, Econometrics and Health (GRECS)], Universidad de Girona. Calle de la Universidad 10, Campus de Montilivi, 17071, Girona, España.
| | - Carmen Martos
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto Aragonés de Ciencias de la Salud, Avda. San Juan Bosco, n°13, 50009, Zaragoza, España.
| | - Pablo Sánchez-Villegas
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Carme Borrell
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España.
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Santosa A, Rocklöv J, Högberg U, Byass P. Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study. BMC Med 2015; 13:65. [PMID: 25889300 PMCID: PMC4393602 DOI: 10.1186/s12916-015-0313-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/06/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden. METHODS A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality. RESULTS A total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002, and 2003-2006. CONCLUSIONS Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25 × 25 target, particularly where substantial premature mortality reductions have already been achieved.
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Affiliation(s)
- Ailiana Santosa
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden.
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden.
| | - Ulf Högberg
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden. .,Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden.
| | - Peter Byass
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden. .,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa.
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153
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De Grande H, Vandenheede H, Deboosere P. Educational inequalities in young-adult mortality between the 1990s and the 2000s: regional differences in Belgium. Arch Public Health 2015; 73:11. [PMID: 25780561 PMCID: PMC4360928 DOI: 10.1186/s13690-014-0059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022] Open
Abstract
Background This study addresses educational inequalities in young-adult mortality between the 1990s and the 2000s by comparing trends in the three different regions in Belgium stratified by sex. Social inequalities in mortality are of major concern to public health but are rarely studied at young ages. Substantial health differences have been found between the Flemish (FR) and Walloon region (WR) concerning (healthy) life expectancy and avoidable mortality, but little is known about regional differentials in young-adult mortality, and comparisons with the Brussels-Capital Region (BCR) have thus far never been made. Methods Data are derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on death and emigration for the periods 01/03/1991-01/03/1999 and 01/10/2001-01/10/2009. Analyses are restricted to young adults aged 25 to 34 years at the moment of each of the censuses. Absolute (directly standardized mortality rates (ASMRs)) and relative (mortality rate ratio using Poisson regression) measures were calculated. Results There is a significant drop in young-adult mortality between the 1990s and the 2000s in all regions and both sexes, with the strongest decline in the BCR (e.g. ASMR of men declined from 165.6 [151.1-180.1] per 100,000 person years to 73.8 [88.3-98.3]). The mortality rates remain highest in the WR in the 2000s Between the 1990s and the 2000s, a remarkable change in the educational distribution occurred as well, with much lower proportions of primary educated in all regions in the 2000s in favour of higher proportions in all other educational levels, especially in higher education. All educational groups show lower mortality over time, except for lower educated men in the FR. Conclusions There is a positive evolution towards lower mortality among the young-adult Belgian population. The WR trails behind in this evolution, which calls for tailored preventive actions. Educational inequalities are marked in all regions and time periods. A more general discussion is needed on the responsibility of society in rendering support and capability to enhance the state of well-being of those not able to achieve a high social position. Electronic supplementary material The online version of this article (doi:10.1186/s13690-014-0059-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannelore De Grande
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
| | - Hadewijch Vandenheede
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
| | - Patrick Deboosere
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
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154
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Morrison J, Pons-Vigués M, Díez E, Pasarin MI, Salas-Nicás S, Borrell C. Perceptions and beliefs of public policymakers in a Southern European city. Int J Equity Health 2015; 14:18. [PMID: 25890326 PMCID: PMC4343064 DOI: 10.1186/s12939-015-0143-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/20/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Methods A qualitative research study describing policymakers’ beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out. Results Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city’s government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities’ limited authority. Conclusions Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector.
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Affiliation(s)
- Joana Morrison
- Department of Epidemiology and Public Health, University College London, London, UK. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain.
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Universitat de Girona, Girona, Spain.
| | - Elia Díez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Maria Isabel Pasarin
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | | | - Carme Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
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155
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Mehta NK, House JS, Elliott MR. Dynamics of health behaviours and socioeconomic differences in mortality in the USA. J Epidemiol Community Health 2015; 69:416-22. [PMID: 25563741 DOI: 10.1136/jech-2014-204248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 12/09/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND To measure the explanatory role of behavioural factors to educational and income disparities in mortality among US adults (ages 25+). METHODS Data were from four waves of the American Changing Lives Study (N=3617). There were 1832 deaths between 1986 and 2011. Smoking, physical activity, alcohol and body mass index were examined. RESULTS Those with 0-11 years of schooling had an 88% (95% CI 48% to 139%) increased risk of dying compared to those with 16+years of schooling. Behavioural factors explained 41% (95% CI 26% to 55%) and 50% (95% CI 30% to 70%) of this excess in models that treated behavioural factors as fixed (single point in time) and time varying (repeated), respectively. The lowest income group (bottom 20th centile) had a 209% (95% CI 172% to 256%) increased risk of dying relative to the highest income group (top 40th centile). Behavioural factors explained 24% (fixed, 95% CI 13% to 35%) and 39% (repeated, 95% CI 22% to 56%) of this difference. Analyses of deaths by causes indicated that behavioural factors were more consequential to disparities in cardiovascular mortality, explaining up to 83% of educational differences, compared to cancer and other death causes. CONCLUSIONS Behavioural factors are one of a number of factors which explain socioeconomic mortality disparities, but their estimated explanatory role depends on a number of parameters including the socioeconomic status measure examined, the cause of death and age. In this nationally representative sample, findings based on repeated measures did not warrant a re-evaluation of earlier estimates.
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Affiliation(s)
- Neil K Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James S House
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael R Elliott
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA Biostatistics Department, University of Michigan, Ann Arbor, Michigan, USA
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156
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Strand BH, Steingrímsdóttir ÓA, Grøholt EK, Ariansen I, Graff-Iversen S, Næss Ø. Trends in educational inequalities in cause specific mortality in Norway from 1960 to 2010: a turning point for educational inequalities in cause specific mortality of Norwegian men after the millennium? BMC Public Health 2014; 14:1208. [PMID: 25418052 PMCID: PMC4256917 DOI: 10.1186/1471-2458-14-1208] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022] Open
Abstract
Background Educational inequalities in total mortality in Norway have widened during 1960–2000. We wanted to investigate if inequalities have continued to increase in the post millennium decade, and which causes of deaths were the main drivers. Methods All deaths (total and cause specific) in the adult Norwegian population aged 45–74 years over five decades, until 2010 were included; in all 708,449 deaths and over 62 million person years. Two indices of inequalities were used to measure inequality and changes in inequalities over time, on the relative scale (Relative Index of Inequality, RII) and on the absolute scale (Slope Index of Inequality, SII). Results Relative inequalities in total mortality increased over the five decades in both genders. Among men absolute inequalities stabilized during 2000–2010, after steady, significant increases each decade back to the 1960s, while in women, absolute inequalities continued to increase significantly during the last decade. The stabilization in absolute inequalities among men in the last decade was mostly due to a fall in inequalities in cardiovascular disease (CVD) mortality and lung cancer and respiratory disease mortality. Still, in this last decade, the absolute inequalities in cause-specific mortality among men were mostly due to cardiovascular diseases (CVD) (34% of total mortality inequality), lung cancer and respiratory diseases (21%). Among women the absolute inequalities in mortality were mostly due to lung cancer and chronic lower respiratory tract diseases (30%) and CVD (27%). Conclusions In men, absolute inequalities in mortality have stopped increasing, seemingly due to reduction in inequalities in CVD mortality. Absolute inequality in mortality continues to widen among women, mostly due to death from lung cancer and chronic lung disease. Relative educational inequalities in mortality are still on the rise for Norwegian men and women.
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Affiliation(s)
- Bjørn Heine Strand
- Division of epidemiology, Norwegian Institute of Public Health, P,O, Box 4404 Nydalen, NO-0403 Oslo, Norway.
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