Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies   Commentary: Unequal inequalities across Europe

Abstract Objectives: To compare countries in western Europe with respect to class differences in mortality from specific causes of death and to assess the contributions these causes make to class differences in total mortality. Design: Comparison of cause of death in manual and non-manual classes, using data on mortality from national studies. Setting: Eleven western European countries in the period 1980-9. Subjects: Men aged 45–59 years at death. Results: A north-south gradient was observed: mortality from ischaemic heart disease was strongly related to occupational class in England and Wales, Ireland, Finland, Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean countries. In the latter countries, cancers other than lung cancer and gastrointestinal diseases made a large contribution to class differences in total mortality. Inequalities in lung cancer, cerebrovascular disease, and external causes of death also varied greatly between countries. Conclusions: These variations in cause specific mortality indicate large differences between countries in the contribution that disease specific risk factors like smoking and alcohol consumption make to socioeconomic inequalities in mortality. The mortality advantage of people in higher occupational classes is independent of the precise diseases and risk factors involved. Key messages Socioeconomic inequalities in total mortality among middle aged men are about equally large in most western European countries, with the exception of larger inequalities in France and Finland Inequalities in mortality from specific causes of death, and the contributions these causes make to inequalities in total mortality, vary between countries The contribution to inequalities in mortality of disease specific risk factors like smoking and alcohol consumption varies greatly between countries This variability imposes limits on the exchange of research findings and experiences with health policies between western European countries The similar size of inequalities in total mortality in most countries underlines the generalised ability of higher occupational classes to better avoid premature death