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Open Access Research article

Trends in educational inequalities in old age mortality in Norway 1961−2009: a prospective register based population study

Joakim Oliu Moe1*, Ólöf Anna Steingrímsdóttir2, Bjørn Heine Strand2, Else-Karin Grøholt2 and Øyvind Næss12

Author affiliations

1 Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1089, Oslo, 0317, Norway

2 Division of Epidemiology, Norwegian Institute of Public Health, Nydalen, P.O. Box 4404, Oslo, 0403, Norway

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Citation and License

BMC Public Health 2012, 12:911  doi:10.1186/1471-2458-12-911

Published: 27 October 2012

Abstract

Background

The vast majority of deaths occur in older adults. Paradoxically, knowledge on long-term trends in mortality inequalities among the aged, and particularly for those aged 80 years and over, is sparse. The historical trends in size and impact of socioeconomic inequalities on old age mortality are important to monitor because they may give an indication on future burden of inequalities. We investigated trends in absolute and relative educational inequalities in old age mortality in Norway between 1961 and 2009.

Methods

We did a register-based population study covering the entire Norwegian population aged 65-94 in the years 1961−2009 (1,534,513 deaths and 29,312,351 person years at risk). By examining 1-year mortality rates by gender, age and educational level we estimated trends in mortality rate ratios and rate differences.

Results

On average, age-standardised absolute inequalities increased by 0.17 deaths per 1000 person-years per year in men (P<0.001), and declined by 0.07 deaths per 1000 person-years per year in women (P<0.001). Trends in rate differences were largest in men aged 75−84 years, but differed in direction by age group in women. The corresponding mean increase in age-standardised relative inequalities was 0.4% and 0.1% per year in men and women, respectively (P<0.001). Trends in rate ratios were largest in the youngest age groups for both genders and negligible among women aged 85−94 years.

Conclusions

While relative educational inequalities in old age mortality increased for both genders, absolute educational inequalities increased only temporarily in men and changed little among women. Our study show the importance of including absolute measures in inequality research in order to present a more complete picture of the burden of inequalities to policy makers. As even in older ages, inequalities represent an unexploited potential to public health, old age inequalities will become increasingly important as many countries are facing aging populations.

Keywords:
Social inequality; Mortality differentials; Health trends; Old age; Nordic welfare model