Published Online
on January 15, 2004

A more recent version of this article appeared on February 1, 2004

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Submitted on September 13, 2003
Accepted on October 1, 2003

Educational Level and Stroke Mortality. A Comparison of 10 European Populations During the 1990s

Mauricio Avendaño MPH^*; Anton E. Kunst PhD; Martijn Huisman MSc; Frank van Lenthe PhD; Matthias Bopp PhD; Carme Borrell PhD; Tapani Valkonen PhD; Enrique Regidor PhD; Giuseppe Costa PhD; Angela Donkin PhD; Jens-Kristian Borgan PhD; Patrick Deboosere MSc; Sylvie Gadeyne MSc; Teresa Spadea MPhil; Otto Andersen PhD; and Johan P. Mackenbach PhD

From the Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands (M.A., A.E.K., M.H., F. van L., J.P.M.); Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland (M.B.); Municipal Health Service, Barcelona, Spain (C.B.); Department of Sociology, University of Helsinki, Helsinki, Finland (T.V.); Department of Preventive Medicine and Public Health, University of Madrid, Madrid, Spain (E.R.); Department of Public Health and Microbiology, University of Turin, Turin, Italy (G.C., T.S.); Health and Care Division, Office for National Statistics, London, UK (A.D.); Division for Health Statistics, Statistics Norway, Oslo, Norway (J-K.B.); Interface Demography, Free University Brussels, Brussels, Belgium (P.D., S.G.); and Research and Methodology Division, Statistics Denmark, Copenhagen, Denmark (O.A.).

^* To whom correspondence should be addressed. E-mail: m.avendanopabon{at}erasmusmc.nl.

Background and Purpose--Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged 30 years in 10 European populations during the 1990s.

Methods--Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy.

Results--Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women.

Conclusions--Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.

Key words: epidemiology • Europe • mortality • social class • stroke

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