Premature cardiovascular mortality in France: divergent evolution between social categories from 1970 to 1990.

BACKGROUND

In France, differences in cardiovascular risk factor distribution have been observed which might be responsible for some disparities in cardiovascular mortality between social categories. The goal of the study was thus to assess the differences in coronary heart disease (CHD) and cerebrovascular diseases (CVD) mortality according to social category, and to determine their trends over the last 20 years in France.

METHODS

Mortality data for CHD, CVD, diseases of the circulatory system (CS) and all causes mortality (TM) were based on death certificates for 1970, 1980 and 1990, and categorized by sex, age group (35-44 and 45-54 years), region and social category.

RESULTS

Among active men, from 1970 to 1990, the overall decrease observed for all causes of death was significantly slower among employees and workers for CHD, CS and TM (P < 0.001), but not for CVD. In 1990, the highest mortality rates were observed among employees and workers for CHD, CVD and CS mortality. In women, no such trend was observed for CHD, CVD or CS mortality. No statistically significant difference between social categories was observed in 1990 for CHD and CVD. In the whole active population, a negative trend for the mortality rates was observed between 1970 and 1990 whatever the cause in both sexes. The ratio between mortality rates among non-active versus active people increased during the two decades in both sexes.

CONCLUSIONS

In men, the inequalities have increased over the last two decades for CHD and have not been reduced for CVD. The category of employees and workers were found to be at special risk for premature cardiovascular disease mortality. Among women, the trends were less clear, although the tendencies were the same. An increasing disparity between active and non-active people suggests that a health-related selection process towards unemployment might have contributed to the decreasing mortality rates observed among employees and workers.