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Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths
  1. Françoise Renard1,
  2. Sylvie Gadeyne2,
  3. Brecht Devleesschauwer1,
  4. Jean Tafforeau1,
  5. Patrick Deboosere2
  1. 1Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
  2. 2Interface Demography, Section Social Research, Free University of Brussels, Brussels, Belgium
  1. Correspondence to Dr Françoise Renard, Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), 14 rue J. Wytsman, Brussels 1050, Belgium; francoise.renard{at}


Background Reducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global inequality.

Methods The 1991 and 2001 Belgian censuses were linked with cause-of-death data, each yielding a study population of over 5 million individuals aged 25–64, followed up for 5 years. Age-standardised mortality rates (ASMR) were computed by educational level (EL) and cause. Inequalities were measured through rate differences (RDs), rate ratios (RRs) and population attributable fractions (PAFs). We analysed changes in educational inequalities between the 1990s and the 2000s, and decomposed the PAF into the main causes of death.

Results All-cause and avoidable ASMR decreased in all ELs and both sexes. Lung cancer, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and suicide in men, and IHD, stroke, lung cancer and COPD in women had the highest impact on population mortality. RDs decreased in men but increased in women. RRs and PAFs increased in both sexes, albeit more in women. In men, the impact of lung cancer and COPD inequalities on population mortality decreased while that of suicide and IHD increased. In women, the impact of all causes except IHD increased.

Conclusion Absolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. The PAFs decomposition revealed that targeting mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women would have the largest impact at population level.

  • Health inequalities

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  • Contributors FR and PD designed the protocol and led the project. PD collected the necessary data. FR and BD performed the statistical analysis. All authors contributed to the interpretation of results. FR wrote the first draft, with all authors providing critical comments. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval Statistical Supervisory Committee of the Commission for the Protection of Privacy.

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