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People with lower levels of education tend to have higher rates of disease and death, compared with people who have higher levels of education. However, because death registrations in Canada do not contain information on the education of the deceased, unlinked vital statistics cannot be used to examine mortality differentials by education.
This study examines cause-specific mortality rates by education in a broadly representative sample of Canadians aged 25 or older. The data are from the 1991 to 2006 Canadian census mortality follow-up study, which included about 2.7 million people and 426,979 deaths. Age-standardized mortality rates (ASMRs) were calculated by education for different causes of death. Rate ratios, rate differences and excess mortality were also calculated.
All-cause ASMRs were highest among people with less than secondary graduation and lowest for university degree-holders. If all cohort members had the mortality rates of those with a university degree, the overall ASMRs would have been 27% lower for men and 22% lower for women. The causes contributing most to that "excess" mortality were ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, stroke, diabetes, injuries (men), and respiratory infections (women). Causes associated with smoking and alcohol abuse had the steepest gradients.
A mortality gradient by education was evident for many causes of death.
Age-standardized mortality rates, rate differences, rate ratios, socio-economic inequalities
The social, economic and environmental conditions that people experience throughout their lives are the most important influences on their health. Known as the social determinants of health, these factors include income, occupation, living conditions, and importantly, education. [Full Text]
Michael Tjepkema (1-613-951-3896; email@example.com) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario K1A 0T6. Russell Wilkins is with the Health Analysis Division and the University of Ottawa. Andrea Long is with the Public Health Agency of Canada, Ottawa, Ontario.
Why is this study important?
- The reduction of socio-economic inequalities in health outcomes is an explicit objective of health policies in Canada.
- Understanding socio-economic inequalities by cause of death may help achieve this objective.
What is already known on this subject?
- All-cause mortality rates are higher for people with relatively low levels of educational attainment.
What this study add?
- If all cohort members had experienced the age-specific mortality rates of those with a university degree, the age-standardized mortality rate would have been 27% lower for men, and 22% lower for women.
- For both sexes, the causes of death contributing most to that "excess" mortality were ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, stroke, diabetes, injuries (men) and respiratory infections (women).
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