Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Trends in educational inequalities in old age mortality in Norway 1961−2009: a prospective register based population study

Authors: Joakim Oliu Moe, Ólöf Anna Steingrímsdóttir, Bjørn Heine Strand, Else-Karin Grøholt, Øyvind Næss

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

The vast majority of deaths occur in older adults. Paradoxically, knowledge on long-term trends in mortality inequalities among the aged, and particularly for those aged 80 years and over, is sparse. The historical trends in size and impact of socioeconomic inequalities on old age mortality are important to monitor because they may give an indication on future burden of inequalities. We investigated trends in absolute and relative educational inequalities in old age mortality in Norway between 1961 and 2009.

Methods

We did a register-based population study covering the entire Norwegian population aged 65-94 in the years 1961−2009 (1,534,513 deaths and 29,312,351 person years at risk). By examining 1-year mortality rates by gender, age and educational level we estimated trends in mortality rate ratios and rate differences.

Results

On average, age-standardised absolute inequalities increased by 0.17 deaths per 1000 person-years per year in men (P<0.001), and declined by 0.07 deaths per 1000 person-years per year in women (P<0.001). Trends in rate differences were largest in men aged 75−84 years, but differed in direction by age group in women. The corresponding mean increase in age-standardised relative inequalities was 0.4% and 0.1% per year in men and women, respectively (P<0.001). Trends in rate ratios were largest in the youngest age groups for both genders and negligible among women aged 85−94 years.

Conclusions

While relative educational inequalities in old age mortality increased for both genders, absolute educational inequalities increased only temporarily in men and changed little among women. Our study show the importance of including absolute measures in inequality research in order to present a more complete picture of the burden of inequalities to policy makers. As even in older ages, inequalities represent an unexploited potential to public health, old age inequalities will become increasingly important as many countries are facing aging populations.
Appendix
Available only for authorised users
Literature
1.
Oeppen J, Vaupel JW: Broken limits to life expectancy. Science. 2002, 296 (5570): 1029-1031. 10.1126/science.1069675.CrossRefPubMed
2.
Christensen K, Doblhammer G, Rau R, Vaupel JW: Ageing populations: the challenges ahead. Lancet. 2009, 374 (9696): 1196-1208. 10.1016/S0140-6736(09)61460-4.CrossRefPubMedPubMedCentral
3.
Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström Ö, Valkonen T, Kunst AE: Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003, 32 (5): 830-837. 10.1093/ije/dyg209.CrossRefPubMed
4.
Strand BH, Grøholt E-K, Steingrímsdóttir ÓA, Blakely T, Graff-Iversen S, Næss Ø: Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000. BMJ. 2010, 340: c654-10.1136/bmj.c654.CrossRefPubMedPubMedCentral
5.
Steingrímsdóttir ÓA, Næss Ø, Moe JO, Grøholt E-K, Thelle DS, Strand BH, Bævre K: Trends in life expectancy by education in Norway 1961–2009. Eur J Epidemiol. 2012, 27 (3): 163-171. 10.1007/s10654-012-9663-0.CrossRefPubMed
6.
Huisman M, Kunst AE, Andersen O, Bopp M, Borgan J-K, Borrell C, Costa G, Deboosere P, Desplanques G, Donkin A, Gadeyne S, Minder C, Regidor E, Spadea T, Valkonen T, Mackenbach JP: Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health. 2004, 58 (6): 468-475. 10.1136/jech.2003.010496.CrossRefPubMedPubMedCentral
7.
Arber S, Ginn J: Gender and inequalities in health in later life. Soc Sci Med. 1993, 36 (1): 33-46. 10.1016/0277-9536(93)90303-L.CrossRefPubMed
8.
Wamala S, Blakely T, Atkinson J: Trends in absolute socioeconomic inequalities in mortality in Sweden and New Zealand. A 20-year gender perspective. BMC Publ Health. 2006, 6 (1): 164-10.1186/1471-2458-6-164.CrossRef
9.
Doblhammer G, Rau R, Kytir J: Trends in educational and occupational differentials in all-cause mortality in Austria between 1981/82 and 1991/92. Wien Klin Wochenschr. 2005, 117 (13–14): 468-479.CrossRefPubMed
10.
Deboosere P, Gadeyne S, Van Oyen H: The 1991-2004 evolution in life expectancy by educational level in Belgium based on linked census and population register data. Eur J Popul. 2009, 25 (2): 175-196. 10.1007/s10680-008-9167-5.CrossRef
11.
Martikainen P, Valkonen T, Martelin T: Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95. J Epidemiol Community Health. 2001, 55 (7): 494-499. 10.1136/jech.55.7.494.CrossRefPubMedPubMedCentral
12.
Martelin T, Koskinen S, Valkonen T: Sociodemographic mortality differences among the oldest old in Finland. J Gerontol B-Psychol. 1998, 53B (2): S83-S90. 10.1093/geronb/53B.2.S83.CrossRef
13.
Jaffe DH, Neumark YD, Eisenbach Z, Manor O: Educational inequalities in mortality among israeli jews: changes over time in a dynamic population. Health Place. 2008, 14 (2): 287-298. 10.1016/j.healthplace.2007.07.003.CrossRefPubMed
14.
Zarulli V, Jasilionis D, Jdanov DA: Changes in educational differentials in old-age mortality in Finland and Sweden between 1971-1975 and 1996-2000. Demogr Res. 2012, 26: 489-510.CrossRef
15.
Kunst AE, Bos V, Andersen O, Cardano M, Costa G, Harding S, Hemström Ö, Layte R, Regidor E, Reid A, Santana P, Valkonen T, Mackenbach JP: Monitoring of trends in socioeconomic inequalities in mortality: experiences from a european project. Demogr Res. 2004, 2 (9): 229-254. Special collectionCrossRef
16.
King NB, Harper S, Young ME: Use of relative and absolute effect measures in reporting health inequalities: structured review. BMJ. 2012, 345: e5774-10.1136/bmj.e5774.CrossRefPubMedPubMedCentral
17.
Harper S, King NB, Meersman SC, Reichman ME, Breen N, Lynch J: Implicit value judgments in the measurement of health inequalities. Milbank Q. 2010, 88 (1): 4-29. 10.1111/j.1468-0009.2010.00587.x.CrossRefPubMedPubMedCentral
18.
Messer LC: Invited commentary: measuring social disparities in health—what was the question again?. Am J Epidemiol. 2008, 167 (8): 900-904. 10.1093/aje/kwn019.CrossRefPubMed
19.
Low A, Low A: Health economics - Importance of relative measures in policy on health inequalities. BMJ. 2006, 332 (7547): 967-969. 10.1136/bmj.332.7547.967.CrossRefPubMedPubMedCentral
20.
Mechanic D: Policy challenges in addressing racial disparities and improving population health - some thoughts on effecting change within the current political and economic realities. Health Aff. 2005, 24 (2): 335-338. 10.1377/hlthaff.24.2.335.CrossRef
21.
Rothman KJ, Greenland S, Walker AM: Concepts of interaction. Am J Epidemiol. 1980, 112 (4): 467-470.PubMed
22.
Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E, Kennedy M: The fall and rise of US inequities in premature mortality: 1960-2002. PLoS Med. 2008, 5 (2): e46-10.1371/journal.pmed.0050046. 227-241CrossRefPubMedPubMedCentral
23.
24.
Marmot MG, Shipley MJ: Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. BMJ. 1996, 313 (7066): 1177-1180. 10.1136/bmj.313.7066.1177.CrossRefPubMedPubMedCentral
25.
Dahl E, Birkelund GE: Health inequalities in later life in a social democratic welfare state. Soc Sci Med. 1997, 44 (6): 871-881. 10.1016/S0277-9536(96)00189-X.CrossRefPubMed
26.
Beckett M: Converging health inequalities in later life - An artifact of mortality selection?. J Health Soc Behav. 2000, 41 (1): 106-119. 10.2307/2676363.CrossRefPubMed
27.
Stevens J, Cai J, Juhaeri , Thun MJ, Williamson DF, Wood JL: Consequences of the use of different measures of effect to determine the impact of age on the association between obesity and mortality. Am J Epidemiol. 1999, 150 (4): 399-407. 10.1093/oxfordjournals.aje.a010019.CrossRefPubMed
28.
Butler RN, Miller RA, Perry D, Carnes BA, Williams TF, Cassel C, Brody J, Bernard MA, Partridge L, Kirkwood T, Martin GM, Olshansky SJ: New model of health promotion and disease prevention for the 21st century. BMJ. 2008, 337 (7662): a399-CrossRefPubMed
29.
Asia Pacific Cohort Studies Collaboration: The impact of cardiovascular risk factors on the age-related excess risk of coronary heart disease. Int J Epidemiol. 2006, 35 (4): 1025-1033.CrossRef
30.
Jousilahti P, Vartiainen E, Tuomilehto J, Puska P: Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation. 1999, 99 (9): 1165-1172. 10.1161/01.CIR.99.9.1165.CrossRefPubMed
31.
32.
33.
Preamble to the Constitution of the World Health Organization as adopted by the International Health, Conference, New york, 19-22 june, 1946; signed on 22 July 1946 by the representatives of 61 states (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 1946, http://​apps.​who.​int/​gb/​bd/​PDF/​bd47/​EN/​constitution-en.​pdf, ; signed on 22 July 1946 by the representatives of 61 states (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948,
34.
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
35.
Scholz R, Maier H: German unification and the plasticity of mortality at older ages. MPIDR Working Paper WP-2003-031. 2003, Rostock: Max Planck Institute for Demographic Research, 1-22.
36.
37.
Hermanson B, Omenn GS, Kronmal RA, Gersh BJ: Beneficial 6-year outcome of smoking cessation in older men and women with coronary-artery disease - results from the CASS registry. N Engl J Med. 1988, 319 (21): 1365-1369. 10.1056/NEJM198811243192101.CrossRefPubMed
38.
Higgins MW, Enright PL, Kronmal RA, Schenker MB, Anton-Culver H, Lyles M: Smoking and lung-function in elderly men and women - the cardiovascular health study. JAMA. 1993, 269 (21): 2741-2748. 10.1001/jama.1993.03500210041029.CrossRefPubMed
39.
Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ: High-intensity strength training in nonagenarians - effects on skeletal-muscle. JAMA. 1990, 263 (22): 3029-3034. 10.1001/jama.1990.03440220053029.CrossRefPubMed
40.
Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ: Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994, 330 (25): 1769-1775. 10.1056/NEJM199406233302501.CrossRefPubMed
41.
Larsson J, Eneroth M, Apelqvist J, Stenström A: Sustained reduction in major amputations in diabetic patients - 628 amputations in 461 patients in a defined population over a 20-year period. Acta Orthop. 2008, 79 (5): 665-673. 10.1080/17453670810016696.CrossRefPubMed
42.
Stuck AE, Egger M, Hammer A, Minder CE, Beck JC: Home visits to prevent nursing home admission and functional decline in elderly people - Systematic review and meta-regression analysis. JAMA. 2002, 287 (8): 1022-1028. 10.1001/jama.287.8.1022.CrossRefPubMed
43.
Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C: Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999, 353 (9147): 93-97. 10.1016/S0140-6736(98)06119-4.CrossRefPubMed
44.
Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J: Prevention of falls and consequent injuries in elderly people. Lancet. 2005, 366 (9500): 1885-1893. 10.1016/S0140-6736(05)67604-0.CrossRefPubMed
45.
Strasser DC, Solomon DH, Burton JR: Geriatrics and physical medicine and rehabilitation: Common principles, complementary approaches, and 21st century demographics. Arch Phys Med Rehabil. 2002, 83 (9): 1323-1324. 10.1053/apmr.2002.34804.CrossRefPubMed
46.
Basile J: Hypertension in the Elderly: A Review of the Importance of Systolic Blood Pressure Elevation. J Clin Hypertens. 2002, 4 (2): 108-119. 10.1111/j.1524-6175.2001.00903.x.CrossRef
47.
Saltvedt I, Mo E-SO, Fayers P, Kaasa S, Sletvold O: Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc. 2002, 50 (5): 792-798. 10.1046/j.1532-5415.2002.50202.x.CrossRefPubMed
48.
Goldberg TH, Chavin SI: Preventive medicine and screening in older adults. J Am Geriatr Soc. 1997, 45 (3): 344-354.CrossRefPubMed
49.
Rubenstein LZ: Joseph T. Freeman award lecture - Comprehensive geriatric assessment: From miracle to reality. J Gerontol A Biol Sci Med Sci. 2004, 59 (5): 473-477. 10.1093/gerona/59.5.M473.CrossRefPubMed
50.
Wan TTH, Lin BY-J, Ma A: Integration mechanisms and hospital efficiency in integrated health care delivery systems. J Med Syst. 2002, 26 (2): 127-143. 10.1023/A:1014805909707.CrossRefPubMed
51.
52.
53.
54.
Shkolnikov VM, Andreev EM, Jdanov DA, Jasilionis D, Kravdal Ø, Vågerö D, Valkonen T: Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 1971-2000. J Epidemiol Community Health. 2011, 66 (4): 372-378.CrossRefPubMed
55.
Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E: Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000, 356 (9235): 1093-1098. 10.1016/S0140-6736(00)02741-0.CrossRefPubMed
56.
Horiuchi S: Causes of Death among the Oldest-Old: Age-Related Changes in the Cause-of-Death Distribution. Human Longevity, Individual Life Duration, and the Growth of the Oldest-Old Population. Edited by: Robine J-M, Crimmins EM, Horiuchi S, Yi Z. 2006, Springer Netherlands, 215-235. Volume 4
57.
Link BG, Phelan J: Social conditions as fundamental causes of disease. J Health Soc Behav. 1995, 35: 80-94.CrossRef
58.
Mackenbach JP: The persistence of health inequalities in modern welfare states: The explanation of a paradox. Soc Sci Med. 2012, 75 (4): 761-769. 10.1016/j.socscimed.2012.02.031.CrossRefPubMed
59.
Rønneberg A, Lund KE, Hafstad A: Lifetime smoking habits among Norwegian men and women born between 1890 and 1974. Int J Epidemiol. 1994, 23 (2): 267-276. 10.1093/ije/23.2.267.CrossRefPubMed
60.
Cavelaars AEJM, Kunst AE, Geurts JJM, Crialesi R, Grötvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Rasmussen NK, Regidor E, Do Rosário-Giraldes M, Spuhler T, Mackenbach JP: Educational differences in smoking: international comparison. BMJ. 2000, 320 (7242): 1102-1107. 10.1136/bmj.320.7242.1102.CrossRefPubMedPubMedCentral
61.
Houweling TAJ, Kunst AE, Huisman M, Mackenbach JP: Using relative and absolute measures for monitoring health inequalities: experiences from cross-national analysis on maternal and child health. Int J Equity Health. 2007, 6 (1): 15-10.1186/1475-9276-6-15.CrossRefPubMedPubMedCentral
Metadata
Title
Trends in educational inequalities in old age mortality in Norway 1961−2009: a prospective register based population study
Authors
Joakim Oliu Moe
Ólöf Anna Steingrímsdóttir
Bjørn Heine Strand
Else-Karin Grøholt
Øyvind Næss
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-911

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue

Research article

The experience of puberty in Iranian adolescent girls: a qualitative content analysis

Research article

Tribal casinos in California: the last vestige of indoor smoking

Research article

Cancer awareness among adolescents in Britain: a cross-sectional study

Research article

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Research article

Does the distribution of health care benefits in Kenya meet the principles of universal coverage?

Research article

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúdecohort study