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Sex differences in child and adolescent mortality by parental education in the Nordic countries
  1. Mika Gissler1,2,
  2. Ossi Rahkonen3,
  3. Laust Mortensen4,
  4. Annett Arntzen5,
  5. Sven Cnattingius6,
  6. Anne-Marie Nybo Andersen7,
  7. Elina Hemminki1
  1. 1National Institute for Health and Welfare, Helsinki, Finland
  2. 2Nordic School of Public Health, Gothenburg, Sweden
  3. 3University of Helsinki, Department of Public Health, Helsinki, Finland
  4. 4National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  5. 5Vestfold University College, Faculty of Social Science, Tønsberg, Norway
  6. 6Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
  7. 7University of Southern Denmark, Odense, Denmark
  1. Correspondence to Professor Mika Gissler, National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland; mika.gissler{at}


Background Socioeconomic position inequalities in infant mortality are well known, but there is less information on how child mortality is socially patterned by sex and age.

Objective To assess maternal and paternal socioeconomic inequalities in mortality by sex, whether these differences vary by age and country, and how much of the sex differences can be explained by external causes of death.

Methods Data on all live-born children were received from national birth registries for 1981–2000 (Denmark: n=1 184 926; Norway: n=1 090 127; and Sweden n=1 961 911) and for 1987–2000 (Finland: n=841 470). Data on the highest level of education in 2000 were obtained from national education registers, and data on mortality and causes of death were received from the national cause-of-death registers until the end of follow-up (20 years or 2003).

Results Boys had a higher child and adolescent mortality than girls. The children of mothers and fathers who had had the shortest education time had the highest mortality for both sexes and for all ages and countries. The differences between the groups with longer than basic education were smaller, particularly among older children and girls. The gradient in mortality was mostly similar for boys and girls. Among 1–19-year-olds, 32% of boys' deaths and 27% of girls' deaths were due to external causes.

Conclusion Boys' excess mortality was only partly explained by educational inequalities or by deaths from external causes. A more detailed analysis is needed to study whether the share of avoidable deaths is higher among children whose parents have had a shorter education time.

  • Birth Register
  • sex
  • parental socio-economic position
  • mortality
  • register study
  • Nordic countries
  • child mortality
  • gender inequalities
  • registers
  • social inequalities
  • socio-economic

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  • Funding The NorCHASE data collection was funded by the Research Programme in Longitudinal Epidemiology, which is supported by the Nordic Council of Ministers and administered by NordForsk (The Nordic Research Board).

  • Competing interests None declared.

  • Ethics approval The study was based on registers in four Nordic countries. All countries received permission to use the confidential register data in scientific research and also ethical approval for the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.