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Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the "fundamental causes" theory of social inequalities in health
Erasmus MC, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands.
Erasmus MC, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands.
Univ Zurich, Inst Social & Prevent Med, CH-8006 Zurich, Switzerland.
Vrije Univ Brussel, Dept Sociol, Brussels, Belgium.
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2015 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, 51-62 p.Article in journal (Refereed) Published
Abstract [en]

Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities.We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30-79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable.Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education-mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large.In conclusion, our results provide some further support for the theory of "fundamental causes". However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.

Place, publisher, year, edition, pages
2015. Vol. 127, 51-62 p.
Keyword [en]
Causes of death, Education, Europe, Fundamental causes, Inequality, Mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-24603DOI: 10.1016/j.socscimed.2014.05.021ISI: 000350074800006Scopus ID: 2-s2.0-84922333690OAI: oai:DiVA.org:miun-24603DiVA: diva2:798368
Note

CODEN: SSMDE

Available from: 2015-03-26 Created: 2015-03-17 Last updated: 2016-09-21Bibliographically approved

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