Linked versus unlinked estimates of mortality and length of life by education and marital status: evidence from the first record linkage study in Lithuania.

Earlier studies have found large and increasing with time differences in mortality by education and marital status in post-Soviet countries. Their results are based on independent tabulations of population and deaths counts (unlinked data). The present study provides the first census-linked estimates of group-specific mortality and the first comparison between census-linked and unlinked mortality estimates for a post-Soviet country. The study is based on a data set linking 140,000 deaths occurring in 2001-2004 in Lithuania with the population census of 2001. The same socio-demographic information about the deceased is available from both the census and death records. Cross-tabulations and Poisson regressions are used to compare linked and unlinked data. Linked and unlinked estimates of life expectancies and mortality rate ratios are calculated with standard life table techniques and Poisson regressions. For the two socio-demographic variables under study, the values from the death records partly differ from those from the census records. The deviations are especially significant for education, with 72-73%, 66-67%, and 82-84% matching for higher education, secondary education, and lower education, respectively. For marital status, deviations are less frequent. For education and marital status, unlinked estimates tend to overstate mortality in disadvantaged groups and they understate mortality in advantaged groups. The differences in inter-group life expectancy and the mortality rate ratios thus are significantly overestimated in the unlinked data. Socio-demographic differences in mortality previously observed in Lithuania and possibly other post-Soviet countries are overestimated. The growth in inequalities over the 1990s is real but might be overstated. The results of this study confirm the existence of large and widening health inequalities but call for better data.