Skip to main content

Causes of death responsible for the widening gap in mortality among educational groups in Austria between 1981 and 1991

Welche Todesursachen sind für den Anstieg der sozialen Sterblichkeitsunterschiede in Österreich zwischen 1981 und 1991 verantwortlich?

Wiener klinische Wochenschrift volume 120, Article number: 547 (2008) Cite this article

Zusammenfassung

HINTERGRUND: Die bildungsspezifischen Ungleichheiten in der Gesamtsterblichkeit sind zwischen 1981 und 1991 beträchtlich angestiegen. Ziel dieser Studie war, jene Todesursachen zu identifizieren, welche vorwiegend für diese Zunahme verantwortlich waren und deren exakten Anteil daran zu berechnen. METHODE: Daten der österreichischen Volkszählungen 1981 und 1991 wurden mit Sterberegisterdaten zusammengeführt. Absolute und relative Ungleichheiten wurden mit einem auf linearer Regression basierendem Ungleichheitsmaß gemessen. ERGEBNISSE: Bei den Männern trugen vorwiegend zunehmende Ungleichheiten bei ischämischen Herzkrankheiten zum Anstieg der Ungleichheiten in der Gesamtsterblichkeit bei. Ohne diesen Anstieg wären die bildungsspezifischen Mortalitätsunterschiede sogar gesunken, denn die Zunahme der Sterblichkeitsunterschiede bei Darmkrebs, Lungenkrebs, Verdauungskrankheiten und alkoholbedingten Todesfällen wurde mehr als ausgeglichen durch den Rückgang der Ungleichheiten bei Tod durch zerebrovaskuläre Krankheiten, sonstige Kreislauferkrankungen, Krankheiten des Atmungssystems und äußere Ursachen. Bei Frauen trugen neben ischämischen Herzkrankheiten auch zunehmende Ungleichheiten bei Todesfällen durch Diabetes und Darmkrebs beträchtlich zum Anstieg der generellen Sterblichkeitsunterschiede bei. Im Gegensatz zu den Ungleichheiten in absoluten Zahlen sind die relativen Sterblichkeitsunterschiede bei den Männern bei Darmkrebs und Verdauungskrankheiten und bei den Frauen bei Diabetes gestiegen. SCHLUSSFOLGERUNGEN: Die zunehmenden Ungleichheiten bei den ischämischen Herzkrankheiten zeigen, wie rasant sich das soziale Gefälle in der Sterblichkeit verändern kann. Gesundheitspolitische Maßnahmen, die sich auf eine Umkehr der angestiegenen Mortalitätsunterschiede konzentrieren, würden einerseits die sozialen Ungleichheiten in der Sterblichkeit reduzieren und sich andererseits positiv auf den generellen Gesundheitszustand der Bevölkerung auswirken.

Summary

OBJECTIVE: In Austria, educational differentials in all-cause mortality increased in the decade between 1981/82 and 1991/92. The aim of this study was to identify which causes of death contributed most to this increase. METHODS: Census records for the Austrian population for the years 1981 and 1991 were linked with death register records for a follow-up period of one year. Education-related disparities in mortality were measured using regression-based indices to determine both absolute and relative levels of inequality at each timepoint and also the changes over the decade. RESULTS: Among men, increasing education-related disparity in deaths from ischemic heart disease was the major contributor to the change in disparity in overall mortality. Without this increase, mortality disparity would have declined, because modest increases in disparity among deaths from colorectal and lung cancers, and digestive and alcohol-associated diseases, were more than offset by reduction of disparity for cerebrovascular and other circulatory diseases, respiratory diseases and external causes. In women, increasing education-related disparity in deaths from ischemic heart disease also contributed most to the slight increase in absolute inequality in overall mortality, but diabetes and colorectal cancer also contributed significantly. In relative terms, there were striking increases in disparity for deaths from colorectal cancer and digestive diseases among men, and for diabetes deaths among women. CONCLUSION: The increase in mortality disparity for ischemic heart disease among men shows how rapidly social gradients in mortality can change. Public health measures concentrating on reversing increasing disparities would not only reduce the mortality gap between social classes but would have a very positive effect on average health status.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • Pamuk ER (1985) Social class inequality in mortality from 1921 to 1972 in England and Wales. Population Studies 39: 17–31

    PubMed  Article  CAS  Google Scholar 

  • Feldman JJ, Makuc DM, Kleinman JC, Cornoni-Huntley J (1989) National trends in educational differentials in mortality. Am J Epidemiol 129(5): 919–933

    PubMed  CAS  Google Scholar 

  • Dahl E, Kjaersgaard P (1993) Trends in socioeconomic mortality differentials in post-war Norway: evidence and interpretations. Sociol Health Illn 15(5): 587–611

    Article  Google Scholar 

  • Pappas G, Queen S, Hadden W, Fisher G (1993) The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med 329(2): 103–109

    PubMed  Article  CAS  Google Scholar 

  • Preston SH, Elo IT (1995) Are educational differentials in adult mortality increasing in the United States. J Aging Health 7(4): 476–496

    PubMed  Article  CAS  Google Scholar 

  • Regidor E, Guitierrez-Fisac JL, Rodriguez C (1995) Increased socioeconomic differences in mortality in eight Spanish provinces. Soc Sci Med 41: 801–807

    PubMed  Article  CAS  Google Scholar 

  • Borrell C, Plasencia A, Pasarin I, Ortun V (1997) Widening social inequalities in mortality: the case of Barcelona, a southern European city. J Epidemiol Community Health 51: 659–667

    PubMed  CAS  Article  Google Scholar 

  • Drever F, Buntig J (1997) Patterns and trends in male mortality. Office for National Statistics, London

    Google Scholar 

  • Harding S, Bethune A, Maxwell R, Brown J (1997) Mortality trends using the Longitudinal Study. Office for National Statistics, London

    Google Scholar 

  • Shkolnikov V, Leon DA, Adamets S, Andreev E, Deev A (1998) Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994. Soc Sci Med 47: 357–369

    PubMed  Article  CAS  Google Scholar 

  • Schalick LM, Hadden WC, Pamuk E, Navarro V, Pappas G (2000) The widening gap in death rates among income groups in the United States from 1967–1986. Int J Health Serv 30(1): 13–26

    PubMed  Article  CAS  Google Scholar 

  • Martikainen P, Valkonen T, Martelin T (2001) Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971–95. J Epidemiol Community Health 55(7): 494–499

    PubMed  Article  CAS  Google Scholar 

  • Valkonen T (2001) Trends in differential mortality in European countries. In: Valin J, Meslé F, Valkonen T (eds) Trends in mortality and differential mortality. Council of Europe Publishing, Strasbourg

    Google Scholar 

  • Turrell G, Mathers C (2001) Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997. Int J Epidemiol 30(2): 231–239

    PubMed  Article  CAS  Google Scholar 

  • Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, et al (2003) Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 32: 830–837

    PubMed  Article  Google Scholar 

  • Huisman M, Kunst AE, Andersen O, Bopp M, Borgan J-K, Borrell C, et al (2004) Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health 58: 468–475

    PubMed  Article  CAS  Google Scholar 

  • Kunst AE, Bos V, Andersen O, Cardano M, Costa G, Harding S (2004) Monitoring of trends in socioeconomic inequalities in mortality: Experiences from a European project. Demographic Research S2(9): 232–254

    Google Scholar 

  • Schwarz F (2007) Widening educational disparities in all-cause mortality: An analysis of Austrian data with international comparisons. Vienna Yearbook of Population Research 2007: 93–105

    Article  Google Scholar 

  • Singh GK, Siahpush M (2006) Widening socioeconomic inequalities in US life expectancy 1980–2000. Int J Epidemiol 35(4): 969–979

    PubMed  Article  Google Scholar 

  • Blakely T, Tobias M, Atkinson J (2008) Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. BMJ 336: 371–375

    PubMed  Article  Google Scholar 

  • Doblhammer G (1997) Socioeconomic differentials in Austrian adult mortality. A study based on linked census and death records for the years 1981/82 [PhD Thesis]. University of Vienna

  • Schwarz F (2007) Causes of death contributing to educational mortality disparities in Austria. Wien Klin Wochenschr 119(9–10): 309–317

    PubMed  Article  Google Scholar 

  • Klotz J (2007) Soziale Unterschiede in der Sterblichkeit; Bildungsspezifische Sterbetafeln 2001/2002. Statistische Nachrichten. Statistik Austria, Wien, pp 296–311

    Google Scholar 

  • Doblhammer G, Rau R, Kytir J (2005) Trends in educational and occupational differentials in all-cause mortality in Austria between 1981/82 and 1991/92. Wien Klin Wochenschr 117(13–14): 468–479

    PubMed  Article  Google Scholar 

  • Rau R, Doblhammer G, Romo VC, Zhang Z (2006) Which causes of death contribute to the widening gap in socioeconomic inequalities in Austrian adult male mortality? European Population Conference; 2006, Liverpool, UK. Available from: http://epc2006.princeton.edu/download.aspx?sub-missionId=60268

  • Blakely T, Fawcett J, Atkinson J, Tobias M, Cheung J (2005) Decades of Disparity II: Socioeconomic mortality trends in New Zealand, 1981–1999. Ministry of Health, New Zealand

    Google Scholar 

  • Hayes LJ, Berry G (2002) Sampling variability of the Kunst-Mackenbach relative index of inequality. J Epidemiol Community Health 56: 762–765

    PubMed  Article  CAS  Google Scholar 

  • Klimont J, Kytir J, Leitner B (2007) Österreichische Gesundheitserhebung 2006/2007. Hauptergebnisse und methodische Dokumentation. Statistik Austria im Auftrag vom Bundesministerium für Gesundheit, Familie und Jugend, Wien

  • Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, et al (2005) Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 59: 395–401

    PubMed  Article  CAS  Google Scholar 

  • Huisman M, Kunst AE, Mackenbach JP (2005) Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 14: 106–113

    PubMed  Article  CAS  Google Scholar 

  • Rieder A, Rathmanner T, Kiefer I, Dorner T, Kunze M, Schwarz F (2004) Österreichischer Diabetesbericht 2004. Daten, Fakten, Strategien. Bundesministerium für Gesundheit und Frauen, Wien

    Google Scholar 

  • Allgemeine Unfallversicherungsanstalt (2005) AUVA – Jahresbericht 2005. Allgemeine Unfallversicherungsanstalt, Wien

    Google Scholar 

  • Statistik Austria (2006) Straßenverkehrsunfälle 2005. Statistik Austria, Wien

    Google Scholar 

  • Valkonen T, Martelin T, Rimpela A, Notkola V, Savela S (1993) Socio-economic mortality differences in Finland 1981–90. Statistics Finland, Helsinki

    Google Scholar 

  • Huisman M, Kunst AE, Mackenbach JP (2003) Socioeconomic inequalities in morbidity among the elderly; a European overview. Soc Sci Med 57: 861–873

    PubMed  Article  Google Scholar 

  • Huisman M, Kunst AE, Bopp M, Borgan J-K, Borrell C, Costa G, et al (2005) Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 365: 493–500

    PubMed  Google Scholar 

  • Avendano M, Kunst AE, Huisman M, Lenthe FV, Bopp M, Regidor E, et al (2006) Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s. Heart 92: 461–467

    PubMed  Article  CAS  Google Scholar 

  • Rogers EM (2003) Diffusion of innovations. 5th edn. Free Press, New York

    Google Scholar 

  • Zilker T (2004) Sucht. In: Classen M, Diehl V, Kochsiek K (eds) Innere Medizin, 5th edn. Urban & Fischer, München

    Google Scholar 

Download references

Author information

Affiliations

  1. Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria

    Franz Schwarz & Elsie R. Pamuk

Authors
  1. Franz Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elsie R. Pamuk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franz Schwarz.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Schwarz, F., Pamuk, E. Causes of death responsible for the widening gap in mortality among educational groups in Austria between 1981 and 1991. Wien Klin Wochenschr 120, 547 (2008). https://doi.org/10.1007/s00508-008-1009-2

Download citation

  • Received:

  • Accepted:

  • DOI: https://doi.org/10.1007/s00508-008-1009-2

Keywords

  • Mortality
  • Causes of death
  • Social disparities
  • Index of inequality
  • Education