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BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Educational inequalities in mortality and associated risk factors: German- versus French-speaking Switzerland

Authors: David Faeh, Matthias Bopp, Swiss National Cohort Study Group

Published in: BMC Public Health | Issue 1/2010

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Abstract

Background

Between the French- and German-speaking areas of Switzerland, there are distinct differences in mortality, similar to those between Germany and France. Assessing corresponding inequalities may elucidate variations in mortality and risk factors, thereby uncovering public health potential. Our aim was to analyze educational inequalities in all-cause and cause-specific mortality in the two Swiss regions and to compare this with inequalities in behavioural risk factors and self-rated health.

Methods

The Swiss National Cohort, a longitudinal census-based record linkage study, provided mortality and survival time data (3.5 million individuals, 40-79 years, 261,314 deaths, 1990-2000). The Swiss Health Survey 1992/93 provided cross-sectional data on risk factors. Inequalities were calculated as percentage of change in mortality rate (survival time, hazard ratio) or risk factor prevalence (odds ratio) per year of additional education using multivariable Cox and logistic regression.

Results

Significant inequalities in mortality were found for all causes of death in men and for most causes in women. Inequalities were largest in men for causes related to smoking and alcohol use and in women for circulatory diseases. Gradients in all-cause mortality were more pronounced in younger and middle-aged men, especially in German-speaking Switzerland. Mortality inequalities tended to be larger in German-speaking Switzerland whereas inequalities in associated risk factors were generally more pronounced in French-speaking Switzerland.

Conclusions

With respect to inequalities in mortality and associated risk factors, we found characteristic differences between German- and French-speaking Switzerland, some of which followed gradients described in Europe. These differences only partially reflected inequalities in associated risk factors.
Appendix
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Literature
1.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008, 358 (23): 2468-2481. 10.1056/NEJMsa0707519.CrossRefPubMed
2.
Bopp M, Minder CE: Mortality by education in German speaking Switzerland, 1990-1997: results from the Swiss National Cohort. Int J Epidemiol. 2003, 32 (3): 346-354. 10.1093/ije/dyg072.CrossRefPubMed
3.
Mackenbach JP: Health inequalities: Europe in profile - An independent, expert report commissioned by the UK Presidency of the EU. 2006, Rotterdam: Dept. of Public Health, Erasmus MC, 41-
4.
Kattainen A, Salomaa V, Harkanen T, Jula A, Kaaja R, Kesaniemi YA, Kahonen M, Moilanen L, Nieminen MS, Aromaa A, et al: Coronary heart disease: from a disease of middle-aged men in the late 1970 s to a disease of elderly women in the 2000s. Eur Heart J. 2006, 27 (3): 296-301. 10.1093/eurheartj/ehi630.CrossRefPubMed
5.
Lozano R, Murray CJL, Lopez AD, Satoh T: Miscoding and misclassification of ischaemic heart disease mortality. Global Programme on Evidence for Health Policy. Working Paper No 12. Volume Sept. 2001, WHO
6.
Lindeboom M, van Doorslaer E: Cut-point shift and index shift in self-reported health. J Health Econ. 2004, 23 (6): 1083-1099.CrossRefPubMed
7.
Faeh D, Minder C, Gutzwiller F, Bopp M: Culture, risk factors and mortality: Can Switzerland add missing pieces to the European puzzle?. J Epidemiol Community Health. 2009, 63 (8): 639-645. 10.1136/jech.2008.081042.CrossRefPubMed
8.
Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrlander C, Rougemont A, Egger M: Cohort Profile: The Swiss National Cohort--a longitudinal study of 6.8 million people. Int J Epidemiol. 2008, Published Online Fist: 7 March 2008
9.
Bundesamt für Statistik. Eidgenössische Volkszählung 2000. Abschlussbericht zur Volkszählung 2000. 2005, Statistik Bundesamt für. Neuchâtel
10.
Bopp M, Gutzwiller F: Die Swiss National Cohort 1990-2000 - eine soziodemografische Datenbasis für longitudinale Gesundheitsanalysen. Swiss National Cohort Report Nr 5, Forschung und Dokumentation 30. 2007, Zürich: Institut für Sozial- und Präventivmedizin
11.
12.
Eichholzer M, Bisig B: Daily consumption of (red) meat or meat products in Switzerland: results of the 1992/93 Swiss Health Survey. Eur J Clin Nutr. 2000, 54 (2): 136-142. 10.1038/sj.ejcn.1600907.CrossRefPubMed
13.
Day NE: Cumulative Rate and Cumulative Risk. Cancer incidence in Five Continents (IARC Scientific Publications No 42). Edited by: Waterhouse JAH, Muir CS, Shanmugaratnam K, Powell J. 1982, Lyon: International Agency for Research on Cancer, 668-670.
14.
Mackenbach JP, Kunst AE: Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997, 44 (6): 757-771. 10.1016/S0277-9536(96)00073-1.CrossRefPubMed
15.
Cavelaars AE, Kunst A, Mackenbach J: Socio-economic differences in risk factors for morbidity and mortality in the European Community. J Health Psychology. 1997, 2 (3): 353-372. 10.1177/135910539700200306.CrossRef
16.
Menvielle G, Kunst AE, Stirbu I, Borrell C, Bopp M, Regidor E, Heine Strand B, Deboosere P, Lundberg O, Leclerc A, et al: Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations?. Int J Cancer. 2007, 121 (3): 649-655. 10.1002/ijc.22721.CrossRefPubMedPubMedCentral
17.
Regidor E, Calle ME, Navarro P, Dominguez V: The size of educational differences in mortality from specific causes of death in men and women. Eur J Epidemiol. 2003, 18 (5): 395-400. 10.1023/A:1024296932294.CrossRefPubMed
18.
Geyer S: Social inequalities in the incidence and case fatality of cancers of the lung, the stomach, the bowels, and the breast. Cancer Causes Control. 2008, 19 (9): 965-974.CrossRefPubMed
19.
Forman D, Newell DG, Fullerton F, Yarnell JW, Stacey AR, Wald N, Sitas F: Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. Bmj. 1991, 302 (6788): 1302-1305. 10.1136/bmj.302.6788.1302.CrossRefPubMedPubMedCentral
20.
Boffetta P: Infection with Helicobacter pylori and parasites, social class and cancer. IARC Sci Publ. 1997, 325-329. 138
21.
Roskam A: Cross-national comparisons of socioeconomic differences in overweight and obesity. 2009, Erasmus University, Inst Maatschappelijke Gezondheidszorg
22.
Breslow RA, Graubard BI: Prospective Study of Alcohol Consumption in the United States: Quantity, Frequency, and Cause-Specific Mortality. Alcohol Clin Exp Res. 2008, 32 (3): 513-521. 10.1111/j.1530-0277.2007.00595.x.CrossRefPubMed
23.
Mukamal KJ, Chiuve SE, Rimm EB: Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles. Arch Intern Med. 2006, 166 (19): 2145-2150. 10.1001/archinte.166.19.2145.CrossRefPubMed
24.
Pagano D, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, et al: Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years. Bmj. 2009, 338: b902-10.1136/bmj.b902.CrossRefPubMedPubMedCentral
25.
Mackenbach JP, Kunst AE, Groenhof F, Borgan JK, Costa G, Faggiano F, Jozan P, Leinsalu M, Martikainen P, Rychtarikova J, et al: Socioeconomic inequalities in mortality among women and among men: an international study. Am J Public Health. 1999, 89 (12): 1800-1806. 10.2105/AJPH.89.12.1800.CrossRefPubMedPubMedCentral
26.
Vaccarino V, Berkman LF, Krumholz HM: Long-term outcome of myocardial infarction in women and men: a population perspective. Am J Epidemiol. 2000, 152 (10): 965-973. 10.1093/aje/152.10.965.CrossRefPubMed
27.
Clarke KW, Gray D, Keating NA, Hampton JR: Do women with acute myocardial infarction receive the same treatment as men?. Bmj. 1994, 309 (6954): 563-566.CrossRefPubMedPubMedCentral
28.
Avendano M, Kunst AE, Huisman M, Lenthe FV, Bopp M, Regidor E, Glickman M, Costa G, Spadea T, Deboosere P, et al: Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s. Heart. 2006, 92 (4): 461-467. 10.1136/hrt.2005.065532.CrossRefPubMed
29.
Mackenbach JP, Huisman M, Andersen O, Bopp M, Borgan JK, Borrell C, Costa G, Deboosere P, Donkin A, Gadeyne S, et al: Inequalities in lung cancer mortality by the educational level in 10 European populations. Eur J Cancer. 2004, 40 (1): 126-135. 10.1016/j.ejca.2003.10.018.CrossRefPubMed
30.
Jousilahti P, Salomaa V, Kuulasmaa K, Niemela M, Vartiainen E: Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women. J Epidemiol Community Health. 2005, 59 (4): 310-315. 10.1136/jech.2004.024349.CrossRefPubMedPubMedCentral
31.
Woods LM, Rachet B, Coleman MP: Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol. 2006, 17 (1): 5-19. 10.1093/annonc/mdj007.CrossRefPubMed
32.
Brown CA, Crombie IK, Tunstall-Pedoe H: Failure of cigarette smoking to explain international differences in mortality from chronic obstructive pulmonary disease. J Epidemiol Community Health. 1994, 48 (2): 134-139. 10.1136/jech.48.2.134.CrossRefPubMedPubMedCentral
33.
Melbostad E, Eduard W, Magnus P: Chronic bronchitis in farmers. Scand J Work Environ Health. 1997, 23 (4): 271-280.CrossRefPubMed
34.
Lorant V, Kunst AE, Huisman M, Costa G, Mackenbach J: Socio-economic inequalities in suicide: a European comparative study. Br J Psychiatry. 2005, 187: 49-54. 10.1192/bjp.187.1.49.CrossRefPubMed
35.
Borrell C, Plasencia A, Huisman M, Costa G, Kunst A, Andersen O, Bopp M, Borgan JK, Deboosere P, Glickman M, et al: Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings. Inj Prev. 2005, 11 (3): 138-142. 10.1136/ip.2004.006346.CrossRefPubMedPubMedCentral
36.
DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P: Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006, 21 (3): 267-275. 10.1111/j.1525-1497.2005.00291.x.CrossRefPubMedPubMedCentral
37.
Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997, 38 (1): 21-37. 10.2307/2955359.CrossRefPubMed
38.
Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, et al: Differences in self reported morbidity by educational level: a comparison of 11 western European countries. J Epidemiol Community Health. 1998, 52 (4): 219-227. 10.1136/jech.52.4.219.CrossRefPubMedPubMedCentral
39.
Jurges H: True health vs response styles: exploring cross-country differences in self-reported health. Health Econ. 2007, 16 (2): 163-178. 10.1002/hec.1134.CrossRefPubMed
40.
von dem Knesebeck O, Verde PE, Dragano N: Education and health in 22 European countries. Soc Sci Med. 2006, 63 (5): 1344-1351. 10.1016/j.socscimed.2006.03.043.CrossRefPubMed
41.
Legleye S: [Geography of French alcohol consumption]. Rev Epidemiol Sante Publique. 2002, 50 (6): 547-559.PubMed
42.
Gorber SC, Tremblay M, Moher D, Gorber B: A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007, 8 (4): 307-326. 10.1111/j.1467-789X.2007.00347.x.CrossRefPubMed
43.
Gutzwiller F, Nater B, Martin J: Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A). Prev Med. 1985, 14 (4): 482-491. 10.1016/0091-7435(85)90008-8.CrossRefPubMed
44.
Eichholzer M, Bernasconi F, Jordan P, Gutzwiller F: Nutrition in Switzerland 2002--results of the Swiss Health Survey. Schweiz Rundsch Med Prax. 2005, 94 (44): 1713-1721.
Metadata
Title
Educational inequalities in mortality and associated risk factors: German- versus French-speaking Switzerland
Authors
David Faeh
Matthias Bopp
Swiss National Cohort Study Group
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-567

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