EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Change in the total and independent effects of education and occupational social class on mortality: analyses of all Finnish men and women in the period 1971–2000

Pekka Martikainen^1,2, Jenni Blomgren², Tapani Valkonen²

¹ Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
² Population Research Unit, Department of Sociology, University of Helsinki, Helsinki, Finland

Correspondence to:
Correspondence to:
Dr P Martikainen
Population Research Unit, Department of Sociology, PO Box 18, University of Helsinki, Helsinki FIN-00014, Finland; pekka.martikainen{at}helsinki.fi

Objectives: To estimate changes in the total and independent effects of education and occupational social class on mortality over 30 years, and to assess the causes of changes in the independent effects.

Methods: Census records linked with death records for 1971–2000 for all Finns aged 30–59 years were studied. The total and independent effects of education and social class on mortality were calculated from relative risks in nested Poisson regression models.

Results: Among men and women, the model shows that the total effects of education, and particularly occupational social class on mortality, have increased over time. Among 40–59-year-old people, the effects of education are currently less independent of social class than in the 1970s, but among younger Finns the independent effects have remained stable. The effects of social class on mortality that are independent of education have grown among people of older ages, particularly among men.

Conclusions: Changes in the independent effects of socioeconomic measures on mortality are determined by changes in their associations with mortality, and distributional changes that affect the strength of the associations between these measures. Distributional changes are driven by changes in educational systems and labour markets, and are of major importance for the understanding of socioeconomic inequalities in mortality.

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