L C Arias1, C Borrell. 1. Servicio de Información Sanitaria, Institut Municipal de la Salut de Barcelona.
Abstract
BACKGROUND: In Spain, individual-based studies on inequalities in mortality are scarce by the fact that death certificate often do not complete information on occupation. This study describes socio-economic inequalities in mortality using as social indicator the level of education, because in Barcelona the mortality registry is linked with the municipal census. MATERIAL AND METHODS: 28,046 residents in Barcelona, Spain, 24 years and older who died in 1992 and 1993 were studied. The level of education of the deceased people was obtained from the municipal census. Age standardized mortality rates were calculated by each educational level by sex. The most important causes of death were studied. Poisson regression models were adjusted to obtain the mortality ratio among the educational levels (being the more educated the reference group). RESULTS: The mortality ratio by all causes in illiterate was 2.05 times higher in males (p < 0.001) and 1.62 in females (p < 0.001). The higher was the education level, the lower were the rates. This mortality pattern was observed in the majority of causes of death studied and mainly in AIDS, cirrhosis and drug overdose, also in lung cancer in males and coronary disease in females. Breast and lung cancer in females were higher in the more educated. Educational inequalities by age group were more important in the youngest people and diminished with increasing age. CONCLUSION: This results show the existence in Barcelona, Spain, of inequalities in mortality by education level in the main causes of death in males and females and in the majority of age groups.
BACKGROUND: In Spain, individual-based studies on inequalities in mortality are scarce by the fact that death certificate often do not complete information on occupation. This study describes socio-economic inequalities in mortality using as social indicator the level of education, because in Barcelona the mortality registry is linked with the municipal census. MATERIAL AND METHODS: 28,046 residents in Barcelona, Spain, 24 years and older who died in 1992 and 1993 were studied. The level of education of the deceased people was obtained from the municipal census. Age standardized mortality rates were calculated by each educational level by sex. The most important causes of death were studied. Poisson regression models were adjusted to obtain the mortality ratio among the educational levels (being the more educated the reference group). RESULTS: The mortality ratio by all causes in illiterate was 2.05 times higher in males (p < 0.001) and 1.62 in females (p < 0.001). The higher was the education level, the lower were the rates. This mortality pattern was observed in the majority of causes of death studied and mainly in AIDS, cirrhosis and drug overdose, also in lung cancer in males and coronary disease in females. Breast and lung cancer in females were higher in the more educated. Educational inequalities by age group were more important in the youngest people and diminished with increasing age. CONCLUSION: This results show the existence in Barcelona, Spain, of inequalities in mortality by education level in the main causes of death in males and females and in the majority of age groups.