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Educational inequalities in falls mortality among older adults: population-based multiple cause of death data from Sweden
  1. Aliasghar Ahmad Kiadaliri1,
  2. Aleksandra Turkiewicz1,
  3. Martin Englund1,2
  1. 1 Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
  2. 2 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Aliasghar Ahmad Kiadaliri, Clinical Epidemiology Unit, kåne University Hospital, Lund SE-221 85, Sweden; aliasghar.ahmad_kiadaliri{at}


Background Falls are the leading cause of fatal injuries among elderly adults. While socioeconomic status including education is a well-documented predictor of many individual health outcomes including mortality, little is known about socioeconomic inequalities in falls mortality among adults. This study aimed to assess educational inequalities in falls mortality among older adults in Sweden using multiple cause of death data.

Methods All residents aged 50‒75 years in the Skåne region, Sweden, during 1998‒2013 (n=566 478) were followed until death, relocation outside Skåne or end of 2014. We identified any mention of falls on death certificates (n=1047). We defined three levels of education. We used an additive hazards model and Cox regression with age as time scale adjusted for marital status and country of birth to calculate slope and relative indices of inequality (SII/RII). We also computed the population attributable fraction of lower educational attainment. Analyses were performed separately for men and women.

Results Both SII and RII revealed statistically significant educational inequalities in falls mortality among men in favour of high educated (SII (95% CI): 15.5 (9.8 to 21.3) per 100 000 person-years; RII: 2.19 (1.60 to 3.00)) but not among women. Among men, 34% (95% CI 19 to 46) of falls deaths were attributable to lower education.

Conclusions There was an inverse association between education and deaths from falls among men but not women. The results suggest that individual’s education should be considered in falls reduction interventions.

  • educational inequality
  • falls mortality
  • multiple-cause-of-death
  • Sweden

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  • Contributors AAK participated in the design, analysis and interpretation of results and drafting the manuscript. AT and ME participated in acquisition of data, interpretation of results and revision of the manuscript for important intellectual content. All authors approved the final manuscript.

  • Funding This work was supported by Greta and Johan Kock Foundations, Crafoord Foundation, the Swedish Research Council, Österlund Foundation and Governmental Funding of Clinical Research within National Health Service (ALF).

  • Competing interests None declared.

  • Ethics approval The study was approved by the Lund University Ethics committee (Dnr 2014/276).

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

  • Data sharing statement No additional data available.