[Death is a respecter of persons : 30 years of research comparing European countries regarding social inequality in mortality].

BACKGROUND

In 1989 the first international comparisons of mortality differences according to educational level and occupational status were published. A few years later systematic comparisons between European countries were initiated at the Erasmus University in Rotterdam. This became a trigger for several European Union (EU)-funded collaboration programs scrutinizing social inequalities in health. The collaboration revealed substantial differences in mortality within and between European populations.

OBJECTIVE

This article provides a synthesis of the most important research results over the past 30 years and also identifies existing research gaps and potentials.

MATERIAL AND METHODS

Descriptive summary of research results comparing European countries regarding male and female all-cause and cause-specific mortality according to educational level and occupational status.

RESULTS

In all European populations analyzed there was a consistent gradient with substantial and in part increasing advantages for higher socioeconomic status groups. There is, however, substantial variation between individual countries. This also applies to trends and cause of death-specific analyses. While relative differences have increased in virtually all populations, absolute differences have often decreased in many populations. Among women and in higher ages the relative differences were smaller. Within Europe, the southern countries had the smallest and the eastern countries the largest gradients. Tobacco and alcohol-related diseases had an especially noteworthy impact on trends and gradients.

CONCLUSION

The evidence for social health inequalities and their determinants has substantially improved during the past 30 years; however, there remains substantial potential for future research questions, for example concerning the contribution of the different phases of life to healthy aging.