Social inequality and environmentally-related diseases in Germany: review of empirical results.

A literature search was conducted aiming at all empirical studies from Germany till mid 1997 containing data on the association between environmentally-related diseases and the socio-economic status (education, occupation, income, social class) and/or on the association between the exposure to harmful substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to the lower social class as compared with the higher social class. This applies to children as well as to adults and to West Germany as well as to East Germany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that allergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kidney cancer or bladder cancer), however, seem to occur more frequently in the lower social class than in the higher social class. Environmental-epidemiological studies should increasingly integrate socio-epidemiological study approaches and explicitly present their results.