Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 8;78(1):18-24.
doi: 10.1136/jech-2023-220599.

Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths

Heidi Amalie Rosendahl Jensen  1 , Sofie Rossen Møller  2 , Anne Illemann Christensen  2 , Michael Davidsen  2 , Knud Juel  2 , Christina Bjørk Petersen  2
Affiliations

Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths

Heidi Amalie Rosendahl Jensen et al. J Epidemiol Community Health. .

Abstract

Background: During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years.

Methods: Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated.

Results: Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality.

Conclusion: Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.

Keywords: EPIDEMIOLOGY; Health inequalities; MORTALITY; PUBLIC HEALTH.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
All-cause (A), smoking-related (B) and alcohol-related (C) mortality rates among men and women in Denmark aged 30–74 years, according to highest attained educational quartile. 1995–2019. Age-standardised rate per 100 000 person-year.
Figure 2
Figure 2
Absolute mortality rate difference between individuals the lowest and the highest educational quartile, according to cause of death group. Men and women aged 30–74 years, by period. 1995–2019. Age-standardised rate per 100 000 person-year.
See this image and copyright information in PMC

Comment in

References

    1. Mackenbach JP, Stirbu I, Roskam A-JR, et al. . Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008;358:2468–81. 10.1056/NEJMsa0707519 - DOI - PubMed
    1. Mackenbach JP, Kulhánová I, Artnik B, et al. . Changes in mortality inequalities over two decades: register based study of European countries. BMJ 2016;353:i1732. 10.1136/bmj.i1732 - DOI - PMC - PubMed
    1. Stringhini S, Dugravot A, Shipley M, et al. . Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med 2011;8:e1000419. 10.1371/journal.pmed.1000419 - DOI - PMC - PubMed
    1. Chetty R, Stepner M, Abraham S, et al. . The association between income and life expectancy in the United States, 2001-2014. JAMA 2016;315:1750–66. 10.1001/jama.2016.4226 - DOI - PMC - PubMed
    1. Brønnum-Hansen H, Baadsgaard M. Widening social inequality in life expectancy in Denmark. A register-based study on social composition and mortality trends for the Danish population. BMC Public Health 2012;12:994. 10.1186/1471-2458-12-994 - DOI - PMC - PubMed

Publication types