Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the "fundamental causes" theory of social inequalities in health
Articolo
Data di Pubblicazione:
2015
Abstract:
Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic
status is a “fundamental cause” which embodies an array of resources that can be used to
avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we
compared the magnitude of inequalities in mortality between more and less preventable causes of death
in 19 European populations, and assessed whether inequalities in mortality from preventable causes are
larger in countries with larger resource inequalities.
We collected and harmonized mortality data by educational level on 19 national and regional populations
from 16 European countries in the first decade of the 21st century. We calculated age-adjusted
Relative Risks of mortality among men and women aged 30e79 for 24 causes of death, which were
classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to
injury prevention, and non-preventable.
Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower
educated, the strength of the educationemortality relation is highly variable between causes of death
and populations. Inequalities in mortality are generally larger for causes amenable to behavior change,
medical intervention and injury prevention than for non-preventable causes. The contrast between
preventable and non-preventable causes is large for causes amenable to behavior change, but absent for
causes amenable to injury prevention among women. The contrast between preventable and nonpreventable
causes is larger in Central & Eastern Europe, where resource inequalities are substantial,
than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but
they are absent or small in Southern Europe, where resource inequalities are also large.
Tipologia CRIS:
03A-Articolo su Rivista
Keywords:
Cause of death; education
Elenco autori:
Mackenbach JP; Kulhanova I; Bopp M; Deboosere P; Eikemo TA; HoffmannR; Kulik MC; Leinsalu M; Martikainen P; Menvielle G; Regidor E; Wojtyniak B; Ostergren O; Lundberg O; Costa G
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