Social inequalities in mortality in causes of death amenable to health care in Norway

Abstract

Objective: Investigate if there are educational inequalities in causes of death considered amenable to health care in Norway and compare this with non-amenable causes.

Methods: The study used the concept of “amenable mortality”, which here includes 34 specific causes of death. A linked data file, with information from the Norwegian Causes of Death Registry and the Educational Registry was analyzed. The study population included the whole Norwegian population in two age groups of interest (25-49 and 50-74 years). Information on deaths was from the period 1990-2001. Education was recorded in 1990 and it was grouped in four categories as: basic, lower secondary, higher secondary and higher. In the study men and women were analysed seperately. The analysis was conducted for all amenable causes pooled with and without ischemic heart disease. A Cox proportional hazard regression model was fitted to estimate hazard rate ratios.

Results: The study showed educational differences in mortality from causes of death considered amenable to health care, in both age groups and sexes. This was seen both when including and excluding ischemic heart disease. The effect sizes were comparable for amenable and non-amenable causes in both age groups and sexes.

Conclusions: This study revealed systematic higher risk of death in lower educational groups in causes of death considered amenable to health care. This indicates potential weaknesses in equitable provision of health care for the Norwegian population. Additional research is needed to identify domains within the health care system of particular concern.