Causes of death contributing to educational mortality disparities in Austria

Abstract

Background: Many studies have shown that mortality increases with decreasing level of education. This paper aims to identify those causes of death that contribute most to educational mortality differentials in Austria, and to reveal those causes of death for which the relative differentials are higher-than-average.

Methods: Individual-level 1991 census and death registry records for the entire Austrian population were linked for a follow-up period of one year. Mortality differentials were measured using the regression-based Relative Index of Inequality (RII).

Results: Causes of death contributing most to educational mortality disparities among men were lung cancer (13%), digestive diseases (13%), ischemic heart disease (12%) and the category 'other circulatory diseases' (11%); among females, corresponding conditions were all circulatory diseases combined (58%) and 'other neoplasms' (14%). Compared to all-cause mortality differential among men (RII = 0.72), larger relative disparities were observed for alcohol-associated deaths (RII = 1.71), followed by digestive and respiratory diseases (RII = 1.21 and 1.07, respectively), stomach and lung cancer (RII = 1.04 and 1.08, respectively), injuries (RII = 1.15) and suicides (RII = 0.97). Among females, disparities that were considerably larger than for all-cause mortality (RII = 0.46) were identified for diabetes (RII = 1.35), injuries (RII = 1.12), cerebrovascular disease (RII = 0.94), respiratory diseases (RII = 0.84) and ischemic heart disease (RII = 0.75). For causes of death combined that are amenable to medical intervention, the differentials were surprisingly large (RII(males) = 0.57; RII(females) = 0.48), given that Austria has a comprehensive, social health-care system.

Conclusion: Efforts to reduce high death rates among the less-educated for identified diseases that contribute largely to overall mortality disparity could increase average life expectancy and improve the general health status of the Austrian population.