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The European Journal of Public Health Advance Access published online on August 10, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki070
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received July 22, 2004
Accepted December 13, 2004

Article

Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period

Marit A. Rognerud 1* and Per-Henrik Zahl 1

1 Norwegian Institute of Public Health, Division of Epidemiology, Oslo, Norway

* To whom correspondence should be addressed.
Marit A. Rognerud, E-mail: marit.rognerud{at}fhi.no


  Abstract

Background: The aim of this paper was to measure socio-economic inequalities in mortality over a 27-year period, and estimate the simultaneous effects of education and income adjusted for changing proportions and potential confounders. Methods: Census data in 1970, 1980 and 1990 with information about income, educational level and household size were linked to mortality records at the individual level and analysed with absolute mortality rates, Poisson regression (univariate and multivariate) and Relative Index of Inequality (RII). Results: Mortality differences increased between income quartiles and educational groups as well as between singles and non-singles. RII between income quartiles increased from 1.6 to 3.6 for men and 1.7 to 2.7 for women while RII between the educational groups increased from 1.6 to 2.8 for men and 1.5 to 2.1 for women. However, RII derived from the adjusted multivariate regression analysis was 1.8 (men) and 1.9 (women) between the income groups in 1990 and 2.2 (men) and 1.7 (women) between the educational groups. In the 1990s current income was more important than previous income, and the rate ratios (RR) increased for groups dropping into the lowest income quartile between two censuses. Conclusion: Low education and single status have become relatively more important risk factors for mortality over time. Confounder effects of education and household size could partly explain the seemingly large increase in inequalities between income groups. Results may also indicate a stronger reverse causation (poor health causing low income) over time.

Keywords: education; income; inequality; mortality; singles; trends.
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