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Causes of death contributing to educational mortality disparities in Austria

Der Beitrag verschiedener Todesursachen zu bildungsspezifischen Unterschieden in der Mortalität in Österreich

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Zusammenfassung

Zahlreiche Studien zeigen eine wesentlich höhere Mortalität unter der sozial benachteiligten Bevölkerung. Diese Arbeit untersucht, welche Todesursachen hauptsächlich für die bildungsspezifischen Differenzen in der Gesamtsterblichkeit in Österreich verantwortlich sind und bei welchen Todesursachen die Ungleichheiten überdurchschnittlich hoch sind. Dazu wurden die Daten der Volkszählung 1991 mit Sterberegisterdaten zusammengeführt. Die Ungleichheiten wurden mit einem auf linearer Regression basierenden Ungleichheitsmaß gemessen. Die größten Beiträge zum bildungsspezifischen Mortalitätsunterschied leisteten bei den Männern die Todesursachen Lungenkrebs (13%), Krankheiten des Verdauungstrakts (13%), koronare Herzkrankheit (12%) und die Kategorie "andere Herzkreislaufkrankheiten" (11%); bei den Frauen trugen mit 58% überwiegend Herzkreislaufkrankheiten wesentlich dazu bei. Betrachtet man die bildungsspezifischen Mortalitätsraten relativ zueinander, dann waren bei den Männern überdurchschnittlich hohe Ungleichheiten bei alkoholassoziierten Krankheiten zu beobachten, gefolgt von Verdauungs- und Atemwegskrankheiten, Magen- und Lungenkrebs, Unfällen und Selbstmorden; bei den Frauen waren es Diabetes, Unfälle, Hirngefäß-, Atemwegs- und koronare Herzerkrankung. Auffällig hoch waren die Ungleichheiten in der Sterblichkeit für alle behandelbaren Krankheiten zusammengenommen, wenn man bedenkt, dass es in Österreich ein umfassendes soziales Gesundheitswesen gibt. Maßnahmen zur Verringerung der Sterberaten unter der sozial benachteiligten Bevölkerung könnten sowohl die durchschnittliche Lebenserwartung erhöhen als auch die generelle Gesundheit der Gesamtbevölkerung deutlich verbessern, insbesondere dann, wenn diese bei den Todesursachen ansetzen, die den größten Beitrag zu den Differenzen leisten.

Summary

BACKGROUND: Many studies have shown that mortality increases with decreasing level of education. This paper aims to identify those causes of death that contribute most to educational mortality differentials in Austria, and to reveal those causes of death for which the relative differentials are higher-than-average. METHODS: Individual-level 1991 census and death registry records for the entire Austrian population were linked for a follow-up period of one year. Mortality differentials were measured using the regression-based Relative Index of Inequality (RII). RESULTS: Causes of death contributing most to educational mortality disparities among men were lung cancer (13%), digestive diseases (13%), ischemic heart disease (12%) and the category 'other circulatory diseases' (11%); among females, corresponding conditions were all circulatory diseases combined (58%) and 'other neoplasms' (14%). Compared to all-cause mortality differential among men (RII = 0.72), larger relative disparities were observed for alcohol-associated deaths (RII = 1.71), followed by digestive and respiratory diseases (RII = 1.21 and 1.07, respectively), stomach and lung cancer (RII = 1.04 and 1.08, respectively), injuries (RII = 1.15) and suicides (RII = 0.97). Among females, disparities that were considerably larger than for all-cause mortality (RII = 0.46) were identified for diabetes (RII = 1.35), injuries (RII = 1.12), cerebrovascular disease (RII = 0.94), respiratory diseases (RII = 0.84) and ischemic heart disease (RII = 0.75). For causes of death combined that are amenable to medical intervention, the differentials were surprisingly large (RIImales = 0.57; RIIfemales = 0.48), given that Austria has a comprehensive, social health-care system. CONCLUSION: Efforts to reduce high death rates among the less-educated for identified diseases that contribute largely to overall mortality disparity could increase average life expectancy and improve the general health status of the Austrian population.

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Schwarz, F. Causes of death contributing to educational mortality disparities in Austria. Wien Klin Wochenschr 119, 309–317 (2007). https://doi.org/10.1007/s00508-007-0790-7

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