Occupational inequalities in cause-specific and all-cause mortality in Europe

Marlen Toch, Norwegian University of Science and Technology
Gwenn Menvielle, Institut National de la Santé et de la Recherche Médicale (INSERM)
Terje A. Eikemo, Erasmus Medical Centre, Rotterdam
Johan P. Mackenbach, Erasmus Medical Centre, Rotterdam

Although life expectancy increases we observe substantial differences in mortality between socioeconomic groups. These inequalities differ considerably between European populations. Such inequalities are unfair, unnecessary and potentially avoidable. Cross country comparisons can help identify the scope for reduction. Europe is a unique region in this respect, as inter country population characteristics as well as history and development between countries differ, and highly reliable and comparable data on mortality and socioeconomic position are available in the majority of the countries. Previous research focussed mainly on educational rather then occupational class inequalities. Thus, the aim of this study is to investigate occupational inequalities in cause-specific and all-cause mortality in Europe at the start of the new millennium. We analyse nationally representative data around the year 2005 on cause-specific and all-cause mortality by occupational class from 12 populations in Europe ranging from Denmark, Finland, and Sweden in the North, to Austria, England and Scotland, France, and Switzerland in central Europe, and Italy (Turin and Tuscany) and Spain (the Basque country and Madrid) in the South. This cross-sectional and longitudinal data was obtained from population censuses and mortality registries from each investigated population. Data were centrally harmonized which enhances cross-country comparability. Men from age 30 to 59 are and Occupational class is analysed according to upper and lower non-manual workers, skilled and unskilled manual workers, as well as self-employed and farmers combined. In order to assess the magnitude of occupational class inequalities, rate ratios for cause-specific and all-cause mortality are estimated with Poisson regression. We corrected the rate ratios to account for an underestimation of mortality inequalities due to exclusion of economically inactive persons. This study contributes to the aim of tackling inequalities in Europe, as it analyses mortality inequalities by occupational class with recent, comprehensive and comparable data from 12 European countries.