Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990-2004.

BACKGROUND: Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. METHODS: We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. RESULTS: In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between -1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. CONCLUSIONS: In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.

Educational inequalities in tuberculosis mortality in sixteen European populations.

OBJECTIVE: To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries. DESIGN: Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities. RESULTS: The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations. CONCLUSIONS: Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century.

AIMS/HYPOTHESIS: The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. METHODS: We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. RESULTS: In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). CONCLUSIONS/INTERPRETATION: In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe.

We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30-74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3-1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7-1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.

Prevalence of some herpesviruses in gingival crevicular fluid.

BACKGROUND: The herpesviruses, ancient pathogens which have co-evoluted with human, are etiologically associated with a number of diseases, from asymptomatic to oncogenic and mortal diseases. It seems that some of them have also an important role in the pathogenesis of human periodontal disease. OBJECTIVE: This study aimed to determine the prevalence of Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), human herpesvirus 8 (HHV-8) and human cytomegalovirus (HCMV) in gingival crevicular fluid (GCF) and, eventually, to find the correlation between specific virus types and clinical parameters which are important in periodontitis, like plaque index (PI), gingival index (GI) and probing depth (PD). STUDY DESIGN: A polymerase chain reaction (PCR) and digestion of PCR products with restriction endonuclease were employed to identify the presence of EBV, HHV-6, HHV-8 and HCMV. RESULTS: Out of 66 samples of GCF taken from the patients with periodontal disease, EBV was found in 29 (43.9%), HHV-6 in 16 (24.2%) and HCMV in 2 (3%) samples, while in the samples of healthy persons, these viruses were not found. HHV-8 was detected neither in the patients with periodontitis nor in healthy control group. More positive results were found in clinical samples taken from people with higher PI and GI and in the samples taken from the patients with medium PD (PD=3-6mm). In all HHV-6 positive samples, we found only variant A; as for EBV positive samples, type A and type B were identified and also co-infection with the two types. It seems that there is a correlation between PI, PD and EBV types, but no correlation was found between EBV types and GI or HHV-6 types and PI, PD, GI. CONCLUSIONS: The present findings confirm some association between herpesviruses and human periodontitis.

Health inequality in Slovenia.

The aim of this study was to correlate some socio-economic factors (gender, income, education, social position) with some health indicators (life expectancy, death rate by selected causes of death, self-evaluation of one's own health, absence from work due to illness or injuries) with a purpose to define the ineqaulity in health across Slovenian municipalities. In our study two sources of data for the population of Slovenia in 1996 were used: from the Statistical Office of the Republic of Slovenia (aggregated data across Slovenian municipalities) and Public Opinion Research (individual data). Statistical analysis was performed by correlation and factor analysis. The correlation coefficient between education and life expectancy is 0.712. The correlation between income base and life expectancy is also significant (0.707). In the eastern part of the country (mostly rural population) women in average live 2 years and men 3 years less than their counterparts in the western part of the country. Five causes of death across Slovenian municipalities are significantly related to the population's education and incomes, of which only death due to neoplasm is positively correlated to income while all other causes are negatively correlated not only with income but also with education. Health (self-evaluation) is closely related to an individual's education and social position. The factor analysis of pressures at work showed groups of two factors as being the most significant: pressures related to leadership positions (positive correlation with health), and physical labour or work in inferior positions (negative correlation with health). We can conclude that the results of our study showed the crucial effect of investigated socio-economic factors on people's health across Slovenian municipalities. During the present socio-economic transition period we are trying to establish new sources of data and looking for possibilities to connect and refine them for further investigation.