Decreasing educational differences in mortality over 40-years: evidence from the Turin Longitudinal Study (Italy)

Abstract

Background Recent studies suggest that inequalities in premature mortality have continued to rise over the last decade in most European countries, but not in southern European countries. Methods In this study, we assess long-term trends in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a recordlinkage study including all individuals resident in Turin in the 1971, 1981, 1991 and 2001 censuses, and aged 30-99 years (more than 2 million people). We examined mortality for all causes, cardiovascular disease (CVD), all cancers and specific cancers (lung, breast), as well as smoking and alcohol-related mortality. Results Overall mortality substantially decreased in all educational groups over the study period, although cancer rates only slightly declined. Absolute inequalities decreased for both genders (SII=962/694 in men/women in 1972-1976 and SII=531/259 in 2007-2011, p<0.01). Among men, absolute inequalities for CVD and alcohol-related causes declined ( p<0.05), while remaining stable for other causes of death. Among women, declines in absolute inequalities were observed for CVD, smoking and alcohol-related causes and lung cancer ( p<0.05). Relative inequalities in all-cause mortality remained stable for men and decreased for women (RII=1.92/2.03 in men/women in 1972-1976 and RII=2.15/1.32 in 2007-2011. Among men, relative inequalities increased for smoking-related causes, while among women they decreased for all cancers, CVD, smoking-related causes and lung cancer ( p<0.05). Conclusions Absolute inequalities in mortality strongly declined over the study period in both genders. Relative educational inequalities in mortality were generally stable among men; while they tended to narrow among women. In general, this study supports the hypothesis that educational inequalities in mortality have decreased in southern European countries.

Forty years of economic growth and plummeting mortality: the mortality experience of the poorly educated in South Korea

“…In recent years, several studies in Western countries have reported secular trends in mortality inequalities 8–17. Education has been commonly used as a socioeconomic position indicator in these studies 8 10–14 16 17. Several of these studies have reported widening differences in mortality between the more and the less educated, despite overall declines in mortality rates 8 11–13 17.…”

Disaggregation of official demographic projections in sub-groups by education level: the neglected “composition effect” in the future path of life expectancy

“…When socioeconomic status was measured by social class, Costa, Zengarini, Demaria, D'Errico, and Leombruni (2013) showed that in Turin, male and female managers at age 65 had life expectancies 3 years and 1 year higher, respectively, than unskilled manual workers. Stringhini et al (2015) found that absolute educational inequality in mortality strongly declined over 40 years in Turin. Relative differences were stable among men and tended to narrow among women.…”