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Martijn Huisman - One of the best experts on this subject based on the ideXlab platform.
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explaining the association between Educational Level and frailty in older adults results from a 13 year longitudinal study in the netherlands
Annals of Epidemiology, 2014Co-Authors: Emiel O Hoogendijk, Martijn Huisman, Hein P J Van Hout, Martijn W Heymans, Henriette E Van Der Horst, Dinnus H M Frijters, Marjolein Broese Van Groenou, Dorly J H DeegAbstract:Abstract Purpose The aim of this study was to examine the longitudinal association between Educational Level and frailty prevalence in older adults and to investigate the role of material, biomedical, behavioral, social, and mental factors in explaining this association. Methods Data over a period of 13 years were used from the Longitudinal Aging Study Amsterdam. The study sample consisted of older adults aged 65 years and above at baseline ( n = 1205). Frailty was assessed using Fried's frailty criteria. A relative index of inequality was calculated for the Level of education. Longitudinal logistic regression analyses based on multiLevel modeling were performed. Results Older adults with a low Educational Level had higher odds of being frail compared with those with a high Educational Level (relative index of inequality odds ratio, 2.94; 95% confidence interval, 1.84–4.71). These differences persisted during 13 years of follow-up. Adjustment for all explanatory factors reduced the effect of Educational Level on frailty by 76%. Income, self-efficacy, cognitive impairment, obesity, and number of chronic diseases had the largest individual contribution in reducing the effect. Social factors had no substantial contribution. Conclusions Our findings highlight the need for a multidimensional approach in developing interventions aimed at reducing frailty, especially in lower educated groups.
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Educational Level and stroke mortality a comparison of 10 european populations during the 1990s
Stroke, 2004Co-Authors: Mauricio Avendano, Anton E Kunst, Enrique Regidor, Matthias Bopp, Martijn Huisman, Frank J Van Lenthe, Carme Borrell, Tapani Valkonen, Giuseppe Costa, Angela DonkinAbstract:Background and Purpose-Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by Educational Level among men and women aged ≥30 years in 10 European populations during the 1990s. Methods-Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between Educational Level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on Educational differences in life expectancy. Results-Differences in stroke mortality according to Educational Level were of a similar magnitude in most populations. However, larger Educational differences were observed in Austria. Overall, Educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce Educational differences in life expectancy by 7% among men and 14% among women. Conclusions-Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to Educational differences in stroke mortality across Europe.
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inequalities in lung cancer mortality by the Educational Level in 10 european populations
European Journal of Cancer, 2004Co-Authors: Johan P. Mackenbach, Matthias Bopp, Patrick Deboosere, Martijn Huisman, Carme Borrell, Giuseppe Costa, Angela Donkin, Otto Andersen, Jenskristian Borgan, Sylvie GadeyneAbstract:Previous studies have shown that due to differences in the progression of the smoking epidemic European countries differ in the direction and size of socioeconomic variations in smoking prevalence. We studied differences in the direction and size of inequalities in lung cancer mortality by the Educational Level of subjects in 10 European populations during the 1990's. We obtained longitudinal mortality data by cause of death, age, sex and Educational Level for 4 Northern European populations (England/Wales, Norway, Denmark, Finland), 3 continental European populations (Belgium, Switzerland, Austria), and 3 Southern European populations (Barcelona, Madrid, Turin). Age- and sex-specific mortality rates by Educational Level were calculated, as well as the age- and sex-specific mortality rate ratios. Patterns of Educational inequalities in lung cancer mortality suggest that England/Wales, Norway, Denmark, Finland and Belgium are the farthest advanced in terms of the progression of the smoking epidemic: these populations have consistently higher lung cancer mortality rates among the less educated in all age-groups in men, including the oldest men, and in all age-groups in women up to those aged 60-69 years. Madrid appears to be less advanced, with less educated men in the oldest age-group and less educated women in all age-groups still benefiting from lower lung cancer mortality rates. Switzerland, Austria, Turin and Barcelona occupy intermediate positions. The lung cancer mortality data suggest that inequalities in smoking contribute substantially to the Educational differences in total mortality among men in all populations, except Madrid. Among women, these contributions are probably substantial in the Northern European countries and in Belgium, but only small in Switzerland, Austria, Turin and Barcelona, and negative in Madrid. In many European countries, policies and interventions that reduce smoking in less educated groups should be one of the main priorities to tackle socioeconomic inequalities in mortality. In some countries, particularly in Southern Europe, it may not be too late to prevent women in less educated groups from taking up the smoking habit, thereby avoiding large inequalities in mortality in the future in these countries.
Anton E Kunst - One of the best experts on this subject based on the ideXlab platform.
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Educational Level and risk of colorectal cancer in epic with specific reference to tumor location
International Journal of Cancer, 2012Co-Authors: Anke M Leufkens, Anton E Kunst, Franzel J B Van Duijnhoven, Hendriek C Boshuizen, Peter D Siersema, Traci Mouw, Anne Tjonneland, Anja Olsen, Kim Overvad, Marie Christine BoutronruaultAbstract:Existing evidence is inconclusive on whether socioeconomic status (SES) and Educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/Educational Level is associated with developing CRC. The aim of our study was to investigate the relationship between Educational Level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow-up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95%CI 0.57–0.94) and for vocational secondary education (HR 0.76, 95%CI 0.58–0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower Educational Level compared to those with a higher Educational Level. This association is most pronounced in women and Southern Europe.
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association between Educational Level and vegetable use in nine european countries
Public Health Nutrition, 2009Co-Authors: Ritva Prättälä, Enrique Regidor, Eva Roos, Samu Hakala, Albertjan R Roskam, Uwe Helmert, Jurate Klumbiene, Herman Van Oyen, Anton E KunstAbstract:Objective: The relationship of socio-economic status and vegetable consumption is examined in nine European countries. The aim is to analyse whether the pattern of socio-economic variation with regard to vegetable consumption is similar in all studied countries with high v. low vegetable availability and affordability, and whether education has an independent effect on vegetable consumption once the effects of other socio-economic factors have been taken into account. Design: The data for the study were obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy and Spain, in 1998 or later. These surveys included data on the frequency of use of vegetables. Food Balance Sheets indicated that the availability of vegetables was best in the Mediterranean countries. The prices of vegetables were lowest in the Mediterranean countries and Germany. Results: Educational Level was positively associated with vegetable consumption in the Nordic and Baltic countries. In the Mediterranean countries, education was not directly associated with the use of vegetables but, after adjusting for place of residence and occupation, it was found that those with a lower Educational Level consumed vegetables slightly more often. Manual workers consumed vegetables less often than non-manual workers, but otherwise there was no systematic association with occupation. Conclusions: The Mediterranean countries did not show a positive association between Educational Level and vegetable consumption. The positive association found in the Northern European countries is linked to the lower availability and affordability of vegetables there and their everyday cooking habits with no long-standing cultural tradition of using vegetables.
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socioeconomic differences in smoking trends among pregnant women at first antenatal visit in sweden 1982 2001 increasing importance of Educational Level for the total burden of smoking
Tobacco Control, 2009Co-Authors: Kontie Moussa, Anton E Kunst, Po Ostergren, Mathias Grahn, Birgitta EssenAbstract:Background: There was a decrease in smoking during early pregnancy in Swedish women between 1982 and 2001. We sought to determine whether there was a parallel decrease in socioeconomic inequality in smoking. Methods: Registry data indicating Educational Level and smoking status at first antenatal visit in all 2 022 469 pregnancies in Sweden 1982-2001 were analysed. Prevalence differences, odds ratios based on prevalences and total attributable fractions were compared for five-year intervals. Results: The prevalence differences of smoking showed a greater decrease at the lowest and middle Educational Level compared with the highest Educational Level (14.5%, 15.7% and 10.2%, respectively) indicating reduced inequality in absolute terms. However, odds ratios regarding low Educational attainment versus high, increased from 5.6 to 14.2, signifying increased inequality in relative terms. Moreover, the total attributable fraction of low and intermediate Educational Level regarding smoking at first antenatal visit increased from 61% to 76% during the period studied. Conclusions: Smoking at first antenatal visit in Sweden between 1982 to 2001 decreased in a way that conclusions regarding trends in inequalities in smoking at first antenatal visit depend on the type of measure applied. However, using the measure of total attributable fraction, which takes into consideration the impact of the exposure on the individual as well as the effect of the varying size of the group of exposed, the growing importance of Educational Level for the behaviour in the population was demonstrated.
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identification of socioeconomic groups at increased risk for smoking in european countries looking beyond Educational Level
Nicotine & Tobacco Research, 2008Co-Authors: Maartje M Schaap, Heleen M E Van Agt, Anton E KunstAbstract:Educational Level is most often used to identify social groups with increased prevalence of smoking. Other indicators of socioeconomic position (SEP) might, however, be equally or even more discriminatory. This study examined the extent to which smoking behavior is related to other socioeconomic indicators in addition to Educational Level. Data were derived from the European Household Panel. We selected data for 45,765 respondents aged 25-60 years from nine European countries. The association between six different SEP indicators and smoking prevalence was examined using prevalence rate ratios (RRs) estimated through log linear regression analyses. In univariate analyses, most selected SEP indicators were associated with smoking. In multivariate analyses, Educational Level, occupational class, accumulated wealth (measured by household assets), and housing tenure retained independent effects on smoking (RRs about 1.20). The effects observed for activity status and household income were small and insignificant in nearly all populations. In northern Europe, Educational Level had the greatest predictive value in the younger age groups; occupational class and housing tenure predicted most of smoking prevalence in the older age groups. The results showed a less pronounced and more varied pattern in southern Europe. Our results indicate that smoking prevalence is related not only to Educational Level but also to occupational class and measures of accumulated wealth (other than income). These measures should be used in addition to Educational Level to identify groups at increased risk for smoking.
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Educational Level and stroke mortality a comparison of 10 european populations during the 1990s
Stroke, 2004Co-Authors: Mauricio Avendano, Anton E Kunst, Enrique Regidor, Matthias Bopp, Martijn Huisman, Frank J Van Lenthe, Carme Borrell, Tapani Valkonen, Giuseppe Costa, Angela DonkinAbstract:Background and Purpose-Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by Educational Level among men and women aged ≥30 years in 10 European populations during the 1990s. Methods-Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between Educational Level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on Educational differences in life expectancy. Results-Differences in stroke mortality according to Educational Level were of a similar magnitude in most populations. However, larger Educational differences were observed in Austria. Overall, Educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce Educational differences in life expectancy by 7% among men and 14% among women. Conclusions-Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to Educational differences in stroke mortality across Europe.
Enrique Regidor - One of the best experts on this subject based on the ideXlab platform.
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inequalities in mortality at older ages decline with indicators of material wealth but persist with Educational Level
European Journal of Public Health, 2015Co-Authors: Laura Reques, Enrique Regidor, Juana M Santos, Maria Jose Belza, David MartinezAbstract:Objective: This study aimed to investigate the relationship between education and different indicators of material wealth with mortality, and to analyze whether this relationship varies with the leading causes of death. Methods: All persons aged 65 and older residing in Spain in 2001 were followed up for 7 years to determine their vital status. The relationship between mortality and four indicators of socioeconomic position (education, number of rooms in home, surface area of home and number of vehicles) was estimated in three age groups: 65-74, 75-84 and 85 and older. Rate ratios and relative index of inequality (RII) were calculated for general mortality and for the leading causes of death by Poisson regression. Results: In women, the mortality rate ratio for low vs. high Educational Level was 1.48 for persons aged 65-74, 1.43 for those aged 75-84 and 1.40 for those aged 85 and older. The respective rates for men were 1.30, 1.25 and 1.29. For the indicators of material wealth, the differences between morality rates in the lower vs. the higher socioeconomic categories decline with age. Mortality differences by the leading causes of death decline with age, except in the case of cancer in women and cardiovascular and digestive mortality in men according to Educational Level. Conclusions: Relative socioeconomic differences in mortality in the older Spanish population decrease with age using indicators of material wealth but not using Educational Level. The variation in the pattern of mortality by cause of death by Level of education may be responsible for these findings.
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association between Educational Level and vegetable use in nine european countries
Public Health Nutrition, 2009Co-Authors: Ritva Prättälä, Enrique Regidor, Eva Roos, Samu Hakala, Albertjan R Roskam, Uwe Helmert, Jurate Klumbiene, Herman Van Oyen, Anton E KunstAbstract:Objective: The relationship of socio-economic status and vegetable consumption is examined in nine European countries. The aim is to analyse whether the pattern of socio-economic variation with regard to vegetable consumption is similar in all studied countries with high v. low vegetable availability and affordability, and whether education has an independent effect on vegetable consumption once the effects of other socio-economic factors have been taken into account. Design: The data for the study were obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy and Spain, in 1998 or later. These surveys included data on the frequency of use of vegetables. Food Balance Sheets indicated that the availability of vegetables was best in the Mediterranean countries. The prices of vegetables were lowest in the Mediterranean countries and Germany. Results: Educational Level was positively associated with vegetable consumption in the Nordic and Baltic countries. In the Mediterranean countries, education was not directly associated with the use of vegetables but, after adjusting for place of residence and occupation, it was found that those with a lower Educational Level consumed vegetables slightly more often. Manual workers consumed vegetables less often than non-manual workers, but otherwise there was no systematic association with occupation. Conclusions: The Mediterranean countries did not show a positive association between Educational Level and vegetable consumption. The positive association found in the Northern European countries is linked to the lower availability and affordability of vegetables there and their everyday cooking habits with no long-standing cultural tradition of using vegetables.
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Educational Level and stroke mortality a comparison of 10 european populations during the 1990s
Stroke, 2004Co-Authors: Mauricio Avendano, Anton E Kunst, Enrique Regidor, Matthias Bopp, Martijn Huisman, Frank J Van Lenthe, Carme Borrell, Tapani Valkonen, Giuseppe Costa, Angela DonkinAbstract:Background and Purpose-Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by Educational Level among men and women aged ≥30 years in 10 European populations during the 1990s. Methods-Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between Educational Level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on Educational differences in life expectancy. Results-Differences in stroke mortality according to Educational Level were of a similar magnitude in most populations. However, larger Educational differences were observed in Austria. Overall, Educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce Educational differences in life expectancy by 7% among men and 14% among women. Conclusions-Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to Educational differences in stroke mortality across Europe.
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trends in obesity differences by Educational Level in spain
Journal of Clinical Epidemiology, 1996Co-Authors: Juan L Gutierrezfisac, Enrique Regidor, Carmen RodriguezAbstract:Our objective was to study the trend in differences in the frequency of obesity by Educational Level in the general population 20 to 64 years of age. We used data from two cross-sectional health surveys carried out in 1987 and 1993 in representative samples of the Spanish population. We investigated the relation between obesity and Educational Level during the periods 1987 and 1993, taking into account the main factors confounding the relation. We used, as setting, the National Health Interview Surveys representative of the whole Spanish population. In both men and women, the highest odds ratios (ORs) for obesity were observed at lower Educational Levels. These differences increased in women between 1987 and 1993, while they decreased in men during the same period. Evidence of increased Educational differences in the frequency of obesity indicates that future studies should focus on the evaluation and monitoring of this trend in the population.
Serge Hercberg - One of the best experts on this subject based on the ideXlab platform.
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blood lipid and lipoprotein Levels relationships with Educational Level and region of residence in the french su vi max study
Preventive Medicine, 2005Co-Authors: E Bruckert, Sebastien Czernichow, Sandrine Bertrais, Francoise C Paillard, Jean Tichet, Pilar Galan, Katia Castetbon, Serge HercbergAbstract:Abstract Background. Blood lipid profile of French men and women obtained from the general population is not well known. Furthermore, the association between these lipids, as a function of other potential risk factors for cardiovascular disease, and sociodemographic factors such as age, Educational Level, and region of residence is not well studied in large samples in Europe. Methods. Data on French healthy volunteers, aged between 40 and 65 years for men (n = 5141) and 35 and 65 years for women (n = 7876) were obtained from the “Supplementation en Vitamines et Mineraux Antioxydants” (SU.VI.MAX) study, a primary prevention trial. Baseline blood samples were collected in 1994–1995 and analyzed for cholesterol, triglyceride, apolipoproteins (apo)-B and -A1. The results were analyzed separately for men and women as a function of age, Educational Level, and area of residence. Results. Overall, blood lipid Levels for men and women did not differ significantly from those reported in other Western industrialized countries. Except for triglyceride in men, all blood lipids were statistically different among ages. In women, cholesterol, apo-A1, and apo-B showed a significant decrease with Educational Level. Statistical differences were found in both genders between blood lipids and lipoproteins among regions of residence. Conclusions. Even if differences between region of residence were found in blood lipid Levels, this cannot explain the North–East to South gradient in the prevalence of cardiovascular disease in France nor differences between France and other industrialized Western countries.
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indicators of abdominal adiposity in middle aged participants of the su vi max study relationships with Educational Level smoking status and physical inactivity
Diabetes & Metabolism, 2004Co-Authors: Sebastien Czernichow, Sandrine Bertrais, Pilar Galan, Serge Hercberg, P Preziosi, J M OppertAbstract:Summary Objectives Abdominal fat accumulation is a risk factor for type 2 diabetes and cardiovascular disease. Identifying the demographic and lifestyle correlates of abdominal adiposity is an important step to target at-risk populations in prevention programs. There are few data of this kind in France. Methods Anthropometric indicators of overall (body mass index, BMI) and abdominal (waist hip ratio, WHR; waist circumference, WC) adiposity, Educational Level, smoking status, and physical activity were assessed in 6,705 middle-aged men and women participating in the SU.VI.MAX study. Results The likelihood of being obese was increased more than twice in physically inactive subjects of both genders after adjustment for age, smoking status and Educational Level (OR = 2.22, CI 95% : 1.74-2.83 in men; OR=2.38, CI 95% : 1.84-3.09 in women). Having a high WHR (≥ 0.95 in men, ≥ 0.80 in women) was more likely in subjects ≥ 50 y, in current smokers, and less likely in men with higher education. The likelihood of having a high WHR was also increased in physically inactive subjects of both genders after adjustment for age, BMI, smoking status and Educational Level (OR = 1.33, CI 95% : 1.10-1.60 in men; OR=1.46, CI 95% : 1.22-1.74 in women). Having a high WC (≥ 102 cm in men, ≥ 88 cm in women) was positively associated with age and also with physical inactivity (OR = 1.63, CI 95% : 1.20-2.22 in women). Conclusions These cross-sectional data suggest significant positive associations of physical inactivity with both the WHR and WC, independently of overall adiposity as assessed by the BMI.
Mauricio Avendano - One of the best experts on this subject based on the ideXlab platform.
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trends in overweight by Educational Level in 33 low and middle income countries the role of parity age at first birth and breastfeeding
Obesity Reviews, 2013Co-Authors: Sandra Lopezarana, Alex Burdorf, Mauricio AvendanoAbstract:This study examined trends in overweight among women of reproductive age by Educational Level in 33 low- and middle-income countries, and estimated the contribution of parity, age at first birth and breastfeeding to these trends. We used repeated cross-sectional Demographic Health Surveys of 255,828 women aged 25-49 years interviewed between 1992 and 2009. We applied logistic regression to model overweight (>25kgm-2) as a function of education, reproductive variables and time period by country and region. The prevalence of overweight ranged from 3.4% in South and Southeast Asia to 73.7% in North Africa West/Central Asia during the study period. The association between education and overweight differed across regions. In North Africa West/Central Asia and Latin American, lower education was associated with higher overweight prevalence, while the inverse was true in South/Southeast Asia and Sub-Saharan Africa. In all regions, there was a consistent pattern of increasing overweight trends across all Educational groups. Older age at first birth, longer breastfeeding and lower parity were associated with less overweight, for differences by Educational Level in overweight prevalence and trends.
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Educational Level and changes in health across europe longitudinal results from share
Journal of European Social Policy, 2009Co-Authors: Mauricio Avendano, Hendrik Jurges, J P MackenbachAbstract:We use cross-national, longitudinal data to explore the impact of Educational Level on changes in health outcomes among Europeans aged over 50. Our analyses are performed separately for Northern, Western and Southern Europe, as these regions broadly represent different welfare state regimes. We find that low education is associated with higher incident events — over a two-year period — of poor health, chronic diseases and disability, but it is less consistently associated with new events of long-standing illness. Net of behavioural risk factors, Educational effects are more consistent in Western and Southern Europe than in the Nordic welfare states. In Northern Europe, lower education is associated with less financial and employment disadvantage than in Southern or Western Europe. After controlling for Educational differences in these factors, effects of Educational Level on health deterioration remain significant for most outcomes in Western and Southern Europe, whereas they are weaker and non-significan...
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Educational Level and stroke mortality a comparison of 10 european populations during the 1990s
Stroke, 2004Co-Authors: Mauricio Avendano, Anton E Kunst, Enrique Regidor, Matthias Bopp, Martijn Huisman, Frank J Van Lenthe, Carme Borrell, Tapani Valkonen, Giuseppe Costa, Angela DonkinAbstract:Background and Purpose-Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by Educational Level among men and women aged ≥30 years in 10 European populations during the 1990s. Methods-Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between Educational Level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on Educational differences in life expectancy. Results-Differences in stroke mortality according to Educational Level were of a similar magnitude in most populations. However, larger Educational differences were observed in Austria. Overall, Educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce Educational differences in life expectancy by 7% among men and 14% among women. Conclusions-Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to Educational differences in stroke mortality across Europe.
