dementia in general to any substantial extent. If anything, persistent smoking may increase rather than decrease the onset rate of dementia, but any net effect on severe dementia cannot be large in either direction.We thank the British doctors some of whom have continued to collaborate in this prospective study of their health for almost half a century, Robert Clarke, Rory Collins, and Christina Davies for their comments, and Cathy Harwood and Gale Mead for preparing the manuscript.Contributors: RD planned the study, IS has for many years conducted it, and RD, RP, and JB planned and conducted the present analyses. RD and RP prepared the report; they will act as guarantors for the paper.Funding: The Medical Research Council has supported the study since 1951 and continues to do so through direct support of the Clinical Trial Service Unit and Epidemiological Studies Unit, helped by the Imperial Cancer Research Fund and British Heart Foundation.Competing interests: None declared. Main outcome measures Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. Results In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. Conclusions These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries. IntroductionSocioeconomic inequalities in health have been found in all countries where data are available, and there is an Until now only a few studies have compared the magnitude of socioeconomic differences in smoking between countries. [5][6][7] The most comprehensive comparison described differences in prevalence of smoking by educational level in the United Kingdom, Finland, Sweden, Norway, and France around 1987. 6 In all these countries, lower educated people smoked more than higher educated people. The largest differences were observed in ...

Background: Currently, poor-rich inequalities in health in developing countries receive a lot of attention from both researchers and policy makers. Since measuring economic status in developing countries is often problematic, different indicators of wealth are used in different studies. Until now, there is a lack of evidence on the extent to which the use of different measures of economic status affects the observed magnitude of health inequalities.

merely brought forward the deaths of those who would have died in the short term anyway or if the induced mortality made a substantial contribution to overall lost lifetime. Methods Data. The Netherlands Central Bureau of Statistics (Voorburg, the Netherlands) provided the numbers of deaths by the day on which the death occurred (1 January 1979-31 December 1997) and by selected causes of death and two age categories (0-64 years of age and ≥ 65 years of age, only for 1 January 1988-31 December 1997). The selected causes of death were malignant neoplasms [International Classification of Diseases, Revision 9 (ICD-9: AM 12-19)], respiratory disease (ICD-9: AM 33-35), and cardiovascular disease (ICD-9: AM 25-32). The Netherlands Royal Meteorological Institute (De Bilt, the Netherlands) provided 24-hr data on minimum and maximum temperatures. The average daily temperature was calculated as the average of the minimum and maximum temperatures. All data refer to the De Bilt station, which is located in the center of the country. Differences in climate within the Netherlands are small, and weather changes usually affect all parts of the country at roughly the same time. Heat waves and cold spells. A heat wave is defined by the Netherlands Royal Meteorological Institute as a period of at least 5 days, each of which has a maximum temperature of at least 25°C, including at least 3 days with a maximum temperature of at least 30°C (measured at the De Bilt station). According to this definition, there were six heat waves in the past 19 years, and they lasted from 6 to 13 days (Figure 1).

Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causes of death and to assess the contributions these causes make to class differences in total mortality. Design: Comparison of cause of death in manual and non-manual classes, using data on mortality from national studies. Setting: Eleven western European countries in the period 1980-9. Subjects: Men aged 45-59 years at death. Results: A north-south gradient was observed: mortality from ischaemic heart disease was strongly related to occupational class in England and Wales, Ireland, Finland, Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean countries. In the latter countries, cancers other than lung cancer and gastrointestinal diseases made a large contribution to class differences in total mortality. Inequalities in lung cancer, cerebrovascular disease, and external causes of death also varied greatly between countries. Conclusions: These variations in cause specific mortality indicate large differences between countries in the contribution that disease specific risk factors like smoking and alcohol consumption make to socioeconomic inequalities in mortality. The mortality advantage of people in higher occupational classes is independent of the precise diseases and risk factors involved.

General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 27 Apr 2019Socioeconomic inequalities in morbidity and mortality in western Europe Johan P Mackenbach, Anton E Kunst, Adriënne E J M Cavelaars, Feikje Groenhof, José J M Geur ts, and the EU Working Group on Socioeconomic Inequalities in Health* THE LANCET SummaryBackground Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mor tality between different countries in western Europe.