Inequalities in women’s mortality by education / Neenakosti v umrljivosti žensk po izobrazbi

Abstract Background: Researchers have found that mortality is decreasing in all socioeconomic population groups but the relative differences in mortality between lower and higher social classes remain unchanged or have even increased. In Slovenia this has not yet been studied. Methods: The analysis included all women in Slovenia who died in the 2005-2010 period and were recorded in the Registry of deaths. Cause of death data was linked to data on the educational attainment of the deceased person, which was applied successfully in 98.8% of cases. The rate ratios (RR) for age-standardised death rates were calculated for women with a low and high educational attainment. Results: The calculated gap in life expectancy at age 30 between women with low and high educational attainment stood at 5.5 years. Women aged 0-84 with a low educational attainment had a statistically significant higher risk of death than women with a high educational attainment (RR=1.65; 95% CI: 1.57-1.73). Inequalities in premature mortality were even greater (1.78; 1.65-1.93). Educational inequalities in premature mortality were revealed in the majority of causes of death, e.g. cervical cancer (1.99; 1.22-3.67), lung cancer (1.70; 1.30-2.26), cardiovascular diseases (3.02; 2.41-3.91), causes directly attributable to alcohol (7.34; 4.96-12.27), motor vehicle accidents (2.23; 1.21-4.45) and suicide (1.68; 1.19-2.41). Conclusions: Significant socioeconomic gaps in women’s mortality in Slovenia obligate us to more systematic monitoring of health inequalities in the future. Further research is required in order to clarify specific reasons for the major gaps in mortality from specific causes of death. Izvleček Izhodišče: Raziskovalci ugotavljajo, da v vseh socialno-ekonomskih skupinah prebivalcev umrljivost pada, vendar relativne razlike v umrljivosti med nižjimi in višjimi socialnimi sloji ostajajo nespremenjene ali so se celo povečale. V Sloveniji doslej to še ni bilo raziskano. Metode: V analizo so bile vključene vse ženske v Sloveniji, ki so umrle v obdobju 2005-2010. Uporabljeno je bilo povezovanje podatkov o vzrokih smrti s podatki o izobrazbi umrlih oseb, ki je bilo uspešno v 98,8 % primerov. Izračunano je bilo razmerje stopenj (RR) starostno standardizirane umrljivosti med nizko in visoko izobraženimi ženskami. Rezultati: Vrzel v pričakovanem trajanju življenja pri starosti 30 let med nizko in visoko izobraženimi ženskami je bila 5,5 let. Nizko izobražene ženske v starosti 0-84 let so imele statistično značilno večje tveganje za smrt kot visoko izobražene (RR=1,65; 95% CI: 1,57-1,73), še večje pa so bile razlike v prezgodnji umrljivosti (1,78; 1,65-1,93). Izobrazbene neenakosti v prezgodnji umrljivosti so se razkrile pri večini vzrokov smrti, npr. rak materničnega vratu (1,99; 1,22-3,67), rak pljuč (1,70; 1,30-2,26), bolezni srca in žilja (3,02; 2,41-3,91), alkoholu neposredno pripisljivi vzroki (7,34; 4,96-12,27), nezgode z motornimi vozili (2,23; 1,21-4,45), samomor (1,68; 1,19-2,41). Zaključki: Velike socialno-ekonomske razlike v umrljivosti žensk v Sloveniji nas zavezujejo k bolj sistematičnemu spremljanju neenakosti v zdravju v prihodnje. Potrebno je nadaljnje raziskovanje, da bi razjasnili specifične razloge za velike razlike v umrljivosti zaradi posameznih vzrokov smrti.