Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults

Reques, Laura; Giráldez‐García, Carolina; Miqueléiz, Estrella; Belza, María José; Regidor, Enrique

doi:10.1136/jech-2014-204186

Cited by 41 publications

(29 citation statements)

References 35 publications

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“…This index has the advantage of providing a unique measure of the magnitude of inequality that can be compared across different countries, studies and diseases. 38 Our estimates of the RII are in line with that reported in a census-based Spanish study based on GC deaths registered between 2001 and 2008, 49 and with the results of the Turin Longitudinal study based on the Piedmont cancer registry collecting data between 1985 and 1999. 50 In these studies, the RII ranged between 1.96 in Spanish men and 3.24 in Italian men, that is, people in the highest rank of the socioeconomic hierarchy had a 30-50% reduction in GC mortality as compared to those in the lowest class.…”

Section: Discussionsupporting

confidence: 86%

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Rota

Alicandro

Pelucchi

et al. 2019

Intl Journal of Cancer

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Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. Our study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta‐analysis within the “Stomach cancer Pooling (StoP) Project”. Educational level and household income were used as proxies for the SEP. We estimated pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study‐specific ORs through random‐effects meta‐analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44–0.84), while the pooled RII was 0.45 (95% CI, 0.29–0.69). A strong inverse association was observed both for noncardia (OR 0.39, 95% CI, 0.22–0.70) and cardia GC (OR 0.47, 95% CI, 0.22–0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04–0.48) as compared to H. pylori positive ones (RII 0.29, 95% CI, 0.10–0.84), in the absence of a significant interaction (p = 0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48–0.89), while the corresponding RII was 0.40 (95% CI, 0.22–0.72). Our collaborative pooled‐analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population.

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Section: Discussionsupporting

confidence: 86%

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Rota

Alicandro

Pelucchi

et al. 2019

Intl Journal of Cancer

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“…Among women, both absolute and relative inequalities in smoking-related deaths decreased over the study period while relative inequalities in lung cancer mortality were inexistent in 1971–1976, and tended to appear in favour of the less educated women over the end of the study period, probably as a consequence of increasing ASMR among the higher educational groups (see online supplementary figure S5). Results for lung cancer are in line with Italian findings of higher smoking rates among women with a high education at the beginning of the study period and among older women at the end of the study period,43 and are similar to those reported in a recent Spanish study 12. Decreasing absolute and relative inequalities in smoking-related mortality, on the other hand, may be explained by the fact that this category comprises heterogeneous causes of death which may be influenced by factors other than smoking.…”

Section: Discussionsupporting

confidence: 90%

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

Stringhini

Spadea

Stroscia

et al. 2015

J Epidemiol Community Health

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BackgroundRecent 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.MethodsIn this study, we assess long-term trends (1971–2011) in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a record-linkage 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.ResultsOverall 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).ConclusionsAbsolute 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.

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“…Researchers have overcome this challenge by conducting (small area) ecological studies (Borrell and Arias 1995;Borrell et al 1997Borrell et al , 2010Esnaola et al 2006;Regidor et al 1995) and by performing linkage studies in local areas, such as Barcelona, Madrid, and the Basque country (Borrell et al 1999;Huisman et al 2004Huisman et al , 2005aMackenbach et al 2008;Puigpinós et al 2009). More recently, based on the 2001 census, Reques et al (2014) conducted a nationally representative follow-up study on individuals aged 25 and older during seven years and estimated mortality rates by education. Their results confirmed those from the earlier mentioned studies showing smaller educational mortality differences in Spain than in other countries in northern Europe.…”

Section: Differences In Longevitymentioning

confidence: 99%

Longevity and Lifespan Variation by Educational Attainment in Spain: 1960–2015

et al. 2018

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For a long time, studies of socioeconomic gradients in health have limited their attention to between-group comparisons. Yet, ignoring the differences that might exist within groups and focusing on group-specific life expectancy levels and trends alone, one might arrive at overly simplistic conclusions. Using data from the Spanish Encuesta Sociodemográfica and recently released mortality files by the Spanish Statistical Office (INE), this is the first study to simultaneously document (1) the gradient in life expectancy by educational attainment groups and (2) the inequality in ageat-death distributions within and across those groups for the period between 1960 and 2015 in Spain. Our findings suggest that life expectancy has been increasing for all education groups but particularly among the highly educated. We observe diverging trends in life expectancy, with the differences between the low-and highly educated becoming increasingly large, particularly among men. Concomitantly with increasing disparities across groups, length-oflife inequality has decreased for the population as a whole and for most education groups, and the contribution of the between-group component of inequality to overall inequality has been extremely small. Even if between-group inequality has increased over time, its contribution has been too small to have sizable effects on overall inequality. In addition, our results suggest that education expansion and declining within-group variability might have been the Post-print. Demography (First online 15 Oct. 2018) 2 main drivers of overall lifespan inequality reductions. Nevertheless, the diverging trends in longevity and lifespan inequality across education groups is an important phenomenon whose underlying causes and potential implications should be investigated in detail.

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Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults

Cited by 41 publications

References 35 publications

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

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

Longevity and Lifespan Variation by Educational Attainment in Spain: 1960–2015

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