Socio-economic Differential Mortality

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1 Sci-ecnmic Differential Mrtality Industrialized Scieties United Natins Ppulatin Divisin (New Yrk) Wrld Health Organizatin (Geneva) Cmmittee fr Internatinal Cperatin in Natinal Research in Demgraphy CICRED (Paris) Istitut di Ricerche sulta Pplazine del Cnsigli Nazinale delle Ricerche (Rma) 1984 Dipartiment di Scienze Demgrafiche dell'università «La Sapienza» (Rma)

2 Sci-ecnmic Differential Mrtality in Industrialized Scieties United Natins Ppulatin Divisin Wrld Health Organizatin (New Yrk) (Geneva) Cmmittee fr Internatinal Cperatin In Natinal Research in Demgraphy CICRED (Paris) Istitut di Ricerche sulla Pplazine del Cnsigli Nazinale delle Ricerche (Rma) 1984 Dipartiment di Scienze Demgrafiche dell'università «La Saplenza» (Rma)

3 SOCIO-ECONOMIC DIFFERENTIAL MORTALITY 3

4 FOREWORD The 3rd Meeting f the UN/WHO/CICRED Netwrk n Sci-Ecnmic Differential Mrtality in the Industrialized Scieties was cnvened in Rme, Italy frm 24 t 27 May, It was attended by 54 researchers (29 Italians and 25 nn-italians) representing 29 institutins (10 Italians and 19 nn-italians). These figures reflect the interest that the researchers take in the prblem f sciecnmic differential mrtality. They als shw the eagerness f ppulatin research institutins t cperate with ne anther, since the rganizatin f the Meeting is based n the principle f self-help, each institutin bearing the cst f its participatin in the cmmn endeavur The Meeting was hsted by the Istitut di Ricerche sulla Pplazine (IRP) f the Cnsigli Nazinale delle Ricerche and the Dipartiment di Scienze Demgraflche (DSD) f the Université di Rma «La Sapienza». The tw hst centres generusly tk charge f the cst f printing the Meeting's prceedings. The CICRED Chairman wishes t thank them sincerely n behalf f the internatinal cmmunity f demgraphers. Jean BOURGEOIS-PICHAT February 1984

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6 TABLE OF CONTENTS pag. Frewrd 5 PART ONE Third Jint UN/WHO/CICRED Meeting n Sci-Ecnmic Differential Mrtality in Industrialized Scieties (Rme, Italy, May 1983) 11 I. Backgrund and general features f the Meeting 13 II. Sessins' reprts.. 1) Classificatin f sci-ecnmic status 14 2) Census based prspective studies 15 3) Prblems and pprtunities fr research n the basis f limited data ) Eclgical and gegraphical apprach 18 5) Infant mrtality and sci-ecnmic status 19 III. Future activities f the Netwrk 1) Publicatin f the prceedings f the Meeting 20 2) Publicatin f a review f the state-f-the-art 20 3) Next meeting f the Netwrk in IV. Recmmandatins 1) Infant mrtality research 21 2) Gegraphical apprach 21 3) Cuntries where census-based prspective studies have nt been implemented 22 4) Cuntries where census-based prspective studies have been implemented ) Data cmparability imprvement 23 6) Disseminatin f findings 23 Annex: List f participating institutins 24 PART TWO Facts and wrks: cuntry reprts 27 I. Classificatin f sci-ecnmic status 29 A nte n the classificatin f sci-ecnmic status fr investigating mrtality differentials in Australia (Alan D. LOPEZ) 31

7 pag. Classificatin f sci-ecnmic status: sme remarks n the discussin in Nrway (Lars B. KRISTOFERSEN) 43 Sci-ecnmic classificatin in Swedish statistics (Rbert ERIKSON) 53 Sci-ecnmic classificatins used in Finnish mrtality studies (Tapani VALKONEN) 63 II. Census-based prspective studies 67 La mrtalité seln le milieu scial en France (Guy DESPLANQUES) 69 Census-based prspective studies in Nrway (Lars B. KRISTOFERSEN) 103 Essai de cnfrntatin de quelques études prspectives de mrtalité (Guy DESPLANQUES) 121 HI. Prblems and pprtunities fr research n the basis f limited data 129 New research directins n sci-ecnmic differential mrtality in the United States f America (Harry M. ROSENBERG and Marilyn M. McMILLEN) 131 Develpments in research n sci-ecnmic determinants f mrtality since 1981 in the Netherlands (Jeren K.S. van GINNEKEN) 167 Recent mrtality change amng wrking vis-à-vis nn wrking ppulatin at age f ecnmic activity and agricultural vis-à-vis nn-agricultural wrkers in Pland (Marek OKOLSKI) 171 Prblems and pssibilities f research in cuntries with limited data (Wilfried LINKE and Jan Van REEK) 179 IV. Gegraphical and eclgical apprach 185 Reginal variatins in mrtality in Nrway (Gerd S. LETTENSTR0M and Jens-Kristian BORGAN) 187 Cnsidératins préliminaires pur une étude sur la mrtalité par causes en Tscane (Silvana SALVINI et Silvana SCHIFINI D'ANDREA 201 Infant mrtality and mther educatin degree at the birth in Italy (Marzia VALLI TODARO) 215 V. Infant mrtality and sci-ecnmic status 221 Mrtalité infantile en Italic La qualité des dnnées et les pssibilités d'améliratin (Marcell NATALE) 223 Facteurs différentiels de la mrtalité fet-infantile en Italie (Antnella PINNELLI) 227 Facteurs sci-démgraphiques des disparités réginales de la mrtalité infantile en France (DINH Quang Chi) 245

8 pag. Infant mrtality in seven Eurpean scialist cuntries (Andras KLINGER) 269 Trends f perinatal and infant mrtality in Sweden and in ther Nrdic cuntries and their assciatin with demgraphic and sci-ecnmic variables (Anne Marie BOLANDER) 283 VI. General Other tpics 321 Brief ntes t describe the psitin f England and Wales cncerning sci-ecnmic differential mrtality (A.Jhn FOX) 323 Quelques réflexins tirées du séminaire de Paris sur «l'influence des plitiques sciales et de santé sur l'évlutin future de la mrtalité» (Jacques VALLIN) 327 Hw gd are the data? Sme methdlgical pints and a quality assessment prgram in Switzerland (Fred PACCAUD and Christph MINDER) 331 Sme features f mrtality in the 1970's in Hungary (Peter JOZAN) 337 A nte n scial inequality f death in mre develped cuntries (Harald HANSLUWKA) 345

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10 11 PART ONE THIRD JOINT UN/WHO/CICRED MEETING ON SOCIO-ECONOMIC DIFFERENTIAL MORTALITY IN THE INDUSTRIALIZED SOCIETIES ROME, ITALY, 24th-27th MAY, 1983

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12 13 I. Backgrund and general features f the meeting In June 1979, a Meeting was jintly cnvened by the United Natins and the Wrld Health Organizatin in Mexic City (Mexic) with a view t assessing the sci-ecnmic determinants and cnsequences f mrtality. The Meeting stressed the need fr further research int the matter and CICRED was assigned the task f prmting research relating t industrialized cuntries. This task fitted int the Prgramme f Inter-Centre Cperative Research launched by the CICRED General Assemly in August The Prgramme is aimed at strenghthening cperatin amng ppulatin research institutins having similar scientific pints f interest and is based n the tw principles f mutual exchange and self help. In view f carrying ut the task assigned by the Mexic City Meeting, CICRED created a Netwrk n Sci-Ecnmie Differential Mrtality in Industrialized Scieties. The first meeting f the Netwrk was cnvened in Geneva (Switzerland) n 3 rd and 4* July 1980 under the jint spnsrship f UN, WHO and CICRED. It was held in the WHO Headquarters. The secnd meeting f the Netwrk was cnvened in Wiesbaden (Federal Republic f Germany) frm 1st t 3rd July it was hsted by the Federal Statistical Office. The prceedings f the tw meetings have been published**). The Wiesbaden meeting decided that the third meeting f the Netwrd wuld be cnvened in Spring 1983 and wuld deal with the fllwing tpics; (i) classificatin f sci-ecnmic status; (ii) prblems and pssibilities f research in cuntries with limited data; (iii) census-based prspective apprach; (iv) eclgical and gegraphical apprach; (v) infant mrtality and sci-ecnmic factrs. Fr each tpic a «fcal persn» was designated. On the jint invitatin f the Istitut di Ricerche sulla Pplazine (IRP) f the Cnsigli Nazinale delle Ricerche and the -Dipartiment di Scienze demgrafiche (DSD) f the Université di Rma «La Sapienza», the United Natins, the Wrld Health Organizatin and CICRED cnvened the third meeting f the Netwrk in Rme (Italy) frm 24 th thrungh 27 th May The pening sessin f the meeting was chaired by Antni Glini. The fllwing speakers welcmed the participants: Lén Tabah, n behalf f the UN Ppulatin Divisin, Harald Hansluwka, n behalf f the WHO Divisin f Glbal Epidemil- ( ) Sci Ecnmic Differential Mrtality in Industrialized Scieties, Vl. 1, UN-WHO-CICRED, 1981,91 pages. Sci Ecnmic Differential Mrtality in Industrialized Scieties, Vl. 2, UN-WHO-CICRED, 1982, 63 pages.

13 14 gical Surveillance and Health Situatin Assessment, Eugeni Snnin, n behalf f DSD, Antni Glini, n behalf f IRP, Jean Burgeis-Pichat, n behalf f CICRED. The meeting held five sessins t discuss the tpics selected in Wiesbaden. Discussins n each tpic are presented in the relevant sessin's reprt (see sectin II belw). Furthermre, the meeting examined three additinal subjects: (i) quality and cmparability f data and findings; (ii) relatinship f research and actin prgrammes; (iii) future activities f the Netwrk. The meeting made varius recmmandatins (see sectin IV belw). The papers cntributed t the meeting are reprduced in Part Tw. II. Sessins' reprts 1. Classificatin f sci-ecnmic status (Fcal persn and rapprteur: A.Jhn Fx) In the first part f the sessin, participants described classificatin f sciecnmic status develped and used in their cuntries, mainly in fficial census publicatins. CICRED will be keeping cpies f these classificatins fr distributin t any researcher wishing t undertake crss-natinal cmparisns. Fr this purpse, it was suggested that each cuntry shuld cntinue t prvide CICRED with up-t-date classificatin as the ld classificatins are mdified. There was sme discussin f the theretical limitatins f rutine appraches t the analysis f sci-ecnmic differentiatin in mrtality (see, fr example, paper by Lpez). There was als sme discussin f the imprtance f mrbidity and health services (again raised by Lpez). The weighting f ccupatin, industry, size f rganizatin and status in the determinatin f sci-ecnmic grup varied by cuntry as did the way in which marginal grups, such as the unemplyed, the sick, the retired, students, husewives and permanently sick peple, were handled (cntrast, fr example, the appraches described by Desplanques, Kristfersen and Fx). Participants varied in their desire fr a sci-ecnmic scale t be «ranked» in a single dimensin. Als, there was sme discussin f classificatin based n: (a) surveys f peples' assessments f a «status», f their designatin f different ccupatinal grups; (b)multivariate classificatins based n, fr example, ccupatin, educatin and incme using statistical techniques such as cluster analysis r factr

14 analysis; (c) univariate classificatin based n husing r educatin and alternatives (see, fr example, Valknen's paper); (d)husehld units, family units r small gegraphic areas. There was als sme discussin f the rle f sci-ecnmic analysis in the status f mrtality differentials. It was widely accepted that, in mst develped cuntries, gvernment plicies in the fields f health, educatin, transprt and husing included strng emphasis n the rle f gvernment agencies in prmting mre equality (f access, f use, etc.). An imprtant rle f sciecnmic analysis was, therefre, a part f the prcess f evaluatin. This meant, in particular, that we shuld bear in mind the need t establish realistic time series data. A mre secndary rle was that in the study f causative factrs. In this sense, it was ften thught t be f imprtance t have access t mre detailed ccupatinal data (the recent use f data published by Denmark, Nrway and Finland illustrates this pint). Other grupings may be equally imprtant (e.g. immigrant grups r race in USA). Nrway (Kristfersen) and the UK (Fx) emphasized the imprtance f ccupatinal histry and scial mbility in prmting a better understanding f differentials. It was cnsequently disappinting t hear frm Denmark (Andersen) that ccupatinal descriptins based n tax register returns were less reliable than thse previusly btained frm censuses.. In trying t change the directin f the discussin t braden hrizns and t persuade researcher and statistical agencies t widen alternative classificatins, Fx briefly cmpared classificatins based n ccupatin, husing and educatin. The headings he cnsidered were: why we measure inequalities; availability f infrmatin; scpe f each measure; cst f data cllectin, cding and rehabilitatin f cding; ppulatin distributin; interactin; scial mbilité; etc Census-based prspective studies (Fcal persn and rapprteur: Guy Desplanques) The cnventinal methd f measuring mrtality levels cnsists f dividing the number f deaths, knwn thrugh vital registratin, by the ttal ppulatin btained frm census data. This can be perated sundly fr the whle cuntry r each regin r each age-sex grup. But as cncerns grups defined by scicnmic r matrimnial status, the measures btained are nt precise. Better measures f mrtality can be made n the basis f the prspective methd r the lngitudinal methd. In the lngitudinal methd, infrmatin n

15 16 the same individuals are gathered and linked frm the varius administrative dcuments: census frm, vital registratin frm, etc. Recrd linkage allws the descriptin f the demgraphic histry f grups f individuals as it develped in the past. This methd has varius ptentialities: (i) it is pssible t study mrtality and als scial mbility, gegraphical mbility, etc. fr grups defined by varius characteristics; (ii) the methd has nt the shrtcmings f the cnventinal methd; (iii) if the grup studied is cnstituted by individuals brn n the same day (r in the same mnth), cllecting infrmatin is easy and at a lwer cst. The prspective methd is similar t the lngitudinal methd but is specifically riented tward the future: a sample f individuals is cnstituted frm the census: they are fllwed up in the curse f time, their varius vital events (marriage, divrce, birth f a child, death,...) being registered. This enables the demgrapher t accurately measure varius demgraphic phenmenns. At present, certain cuntries have published findings btained n the basis f lngitudinal r prspective methds(*>: Denmark, Finland, France, Nrway, United Kingdm. The findings, and thse unpublished which were prvided by the participants t the meeting, gave rise t many new insights in the field f mrtality differentials: thse wh wn their huse r apartment have a lwer mrtality level than tenants (England and Wales). the mrtality gap between scial grups is widening (France), the mrtality rate is higher amng thse unemplyed than thse wrking; thse wh are ecnmically inactive die mre frequently than d the active peple, the frequency f certain causes f death varies accrding t the scial grup, etc. (*) DENMARK. Ddelighed g erhverv (Occupatinal mrtality), , Statistike Undersgelser n 37, Kbenhavn, NORWAY. Occupatinal mrtality, Central Bureau f Statistics Rapprter 79/19, Osl, 1979 (by Kirstfersen); Occupatinal mrtality , Statistiske Analyser n" 21, Osl FINLAND. Occupatinal Mrtality (by H. Sauli), Central Statistical Office f Finland, n 54, Helsinki, FRANCE. La mrtalité des adultes seln le milieu scial: Résultats de la péride (par G. Desplanques), Cllectins de l'insee, série D, n 44. ' UNITED KINGDOM. Lngitudinal Study: sci-demgraphic mrtality differentials , Series LS, n I (by Jhn Fx and Peter Gldblatt), HMSO, 1982.

16 These findings are s far mstly descriptive. It is hped that in the future the develpment f research will make it pssible t answer the kind f questins such as: Des the situatin f unemplyment r that f widwhd increase the death risk? Is the ccupatinal activity f the childbearing mther psitive f negative t the health f her futur child?... As pinted ut abve many cuntries have cnducted mrtality studies n the basis f the lngitudinal and/r prspective methd. Others have recently adpted it: Italy, Austria, Sweden, the latter being at the stage f data analysis. The implementatin f the legislatin n medical secrecy r fr the prtectin f the individuals freedm (Netherlands, France,...) culd be an bstacle t such a develpment Prblems and pprtunities fr research n the basis f limited data (Fcal persn and rapprteur: Wilfried Linke) Sme backgrund infrmatin was given n the activities f an infrmal wrking grup which was held in Wiesbaden n 15 th and 16'h June, 1982, in preparatin fr the present sessin. The meeting was attended by participants frm Netherlands, Switzerland, the Federal Republic f Germany and the WHO. Subjects f the discussins were the prblems and pssibilities f research n differential mrtality in situatins with privacy limitatins and where linkage f recrds is difficult r nt pssible. The participants reprted abut the research wrk they had undertaken in the past r were planning fr the future. As a result f the discussins held, a paper was prepared and submitted t this meeting!*). It cntains the fllwing three paragraphs:. A. Necessity f resarch int sci-ecnmic differential mrtality; B. Feasibility f research int sci-ecnmic differential mrtality in industrialized scieties with privacy limitatins; C. Investigatin f the phase preceeding death. Paragraph B which is the mst imprtant part f the paper, was cntributed by Mr. Van Reek. The fcal persn intended t prepare a schedule f current and planned investigatins especially using nn-recrd-linkage methds. Fr this aim the members f the Netwrk were invited t prvide infrmatin abut the bjectives, the surce f data and the methds applied in investigatins f this kind. Three cntributins were received frm Mr. Van Ginneken (The (*) Reprduced in Part Tw.

17 18 Netherlands), Mr. Rsenberg (USA) and Mr. Oklski (Pland). It shuld be nted in this cntext that fr the cming years in the USA, several studies making use f linkage f recrds are planned. Similar studies, hwever, are nt planned fr the ther cuntries mentined abve. In the Federal Republic f Germany, it is intended t perfrm a brader evaluatin f files f wrkers and emplyees subject t cmpulsry scial ld age insurance. It wuld permit a detailed evaluatin f deaths f the grups mentined by demgraphic and sci-ecnmic characteristics. There was an agreement, that studies with the design mentined in the secnd part f the backgrund paper wuld give useful infrmatin fr thse cuntries in which recrd linkage is difficult r impssible. Such studies might be seen as a first step twards determining the extent f differential mrtality. Their limitatins were als cnsidered. It was hped that such studies will be fllwed by studies using lngitudinal r prspective design. 4. Eclgical and gegraphical apprach (Fcal persn and rapprteur: Antni Glini) Three papers were submitted fr the sessin. They dealt with gegraphical variatins f the causes f death in Tuscany (S. Selvini and S. Schifini d'andrea), the reginal variatins f the mrtality level in Nrway (G. S. Lettenstrm and J. K. Brgan) and the reginal variatins f the Italian infant mrtality rate with relatin t the mthers' educatin (M. Valli Tdar). The discussin went beynd the findings gathered in these papers. In almst all cuntries there are strng reginal differences, bth in life expectancy and age-sex specific prbabilities f dying. In many cases, such differences are persisting r bradening in the curse f time. Fr instance, in Italy, the gap between the maximal and minimal regial values f e l5 fr males was 5.5 years in (58.1 against 52.6) and als 5.5 years in (60.2 against 54.7). Ging dwnward in the territrial scale and bserving smaller territrial units, the gap is larger, at arund 8-10 years. In each cuntry reginal differences in mrtality are mre imprtant fr males than fr females. Such gegraphical differences cannt always be explained by reginal variatins f health facilities r sci-ecnmic level. The «eclgical apprach» takes int accunt a larger number f variables. It seems a very useful tl fr a better understanding f gegraphical mrtality differentials. A greater number f eclgical surveys shuld be encuraged.

18 19 5. Infant mrtality and sci-ecnmic status (Fcal persn and rapprteur: Anne-Marie Blander) After the presentatin f the cntributed papers (reprduced in Part Tw), there was a brief discussin n sme prblems related t the analysis f perinatal and infant mrtality and their assciatin t sci-ecnmic and demgraphic variables. Attentin was paid. t the fact that differences related t the ccupatin f father had nt the same significance as thse related t that f the mther neither fr deaths arund the birth, nr in the pstnenatal perid. As a rule the number f deaths are ften t lw in the Nrdic cuntries t achieve any statistical significance. It was als pinted ut that birth-weight culd serve as a substitute fr mrtality in cuntries with cmplete reprting f such data as it wuld frm a mre sensitive measurement f sci-ecnmic and ther differences. An ther prblem mentined in this cnnectin was the adjustment fr differences in birth distributin, similar t thse ften made fr age differences in grups t be cmpared. The danger f such standardisatins was underlined especially as regards perinatal mrtality, where lw birth-weight is ne f the best indicatrs f increased risks f dying when cmparing different grups. General birth-weight differences as thse between male and female births shuld evidently be cntrlled fr when estimating the risks. The very lw incidence f pregnancies in yung mthers (under 20 years) in the Nrdic cuntries, culd pint at a negative selectin as t sci-ecnmic factrs, which wuld explain part f the mrtality risks in this grup. Graphs shwing the percentage distributin accrding t mthers age in Sweden gave sme evidence f the presence f selective r cnfunding factrs t be aware f when studying the births f the yungest as well as the ldest mthers. A cmparisn f late fetal and early nenatal mrtality between the 8 cuntries participating in the WHO study f the 1973 births revealed a prbable underreprting in Japan f deaths within in first days f life and a crrespnding verreprting f late fetal deaths, which was cnfirmed by the Japanese participant in the meeting. This had caused a slight miscalculatin in the infant mrtality rate and thus als in the life expectancy at birth, a mistake that had been detected and was n its way t be crrected. The cnclusin f the discussin f the infant mrtality sessin was the need fr mre research in this field, especially as regards the study f differentials within and between cuntries.

19 20 III. Future activities f the Netwrk The activities mentined belw are apprved by the participants t the meeting. 1. Publicatin f the prceedings f the Meeting The reprt f the Meeting and the cntributed papers will be gathered in a bk and published in Spring 1984, with the assistance f the tw hst centres, the Institute f Ppulatin Research f the Natinal Cuncil f Research f Italy and the Department f Demgraphic Science f the University f Rme «La Sapienza». The bk will bear the n 3 f the Sci Ecnmic Differential Mrtality in the Industrialized Scieties series. It will cnstitute a cntributin f the Netwrk t the frthcming Internatinal Ppulatin Cnference, cnvened by the United Natins in Mexic City (Mexic) in August Publicatin f a review f the state-f-the-art Under the respnsibility f A.Jhn Fx, and with the assistance f the Wrld Health Organizatin, a review f the state-f-the-art will be drafted and published in It will bear the n 4 f the Sci Ecnmic Differential Mrtality in the Industrialized Scieties Series. 3. Next meeting f the Netwrk in 1986 The furth meeting f the Netwrk will be cnvened in Spring The members f the Netwrk are invited t deply all effrts t carry ut new pieces f research n sci-ecnmic differential mrtality during the cming years in view f actively cntributing t the 1986 meeting. There will be tw categries f cntributed papers: (i) natinal reprts prviding the findings f studies carried ut in each cuntry during the perid; (ii)transnatinal reprts which cnstitute in-depth analyses f certain specific tpics, in a transnatinal perspective. As cncerns the secnd categry f cntributed papers, the fllwing tpics are selected and taken in charge by vlunteering participants: Cmparative study f sci-ecnmic differential mrtality in Eastern

20 Eurpean cuntries (Peter Jzan, Central Statistical Office f Hungary, Budapest); Cmparative study f sci-ecnmic differential mrtality in Western Eurpean cuntries (Lars Kristfersen, Central Bureau f Statistics f Nrway, Osl); Quality f cause-f-death infrmatin as related t sci-ecnmic differential mrtality (Harry M. Rsenberg, Natinal Center fr Health Statistics, Hyattsville, Maryland, USA); Elabratin f theretical framewrk fr sci-ecnmic differential mrtality (Tapani Valknen, Department f Scilgy, University f Helsinki, Finland); Explanatin f sci-ecnmic differential mrtality amng the ecnmically inactive peple (Jacques Vallin, Institut Natinal d'etudes Démgraphiques, Paris, France); Migratin and mrtality (Antni Glini, Istitut di Ricerche sulla Pplazine, Rma, Italy); Scial mbility and mrtality (Rbert Eriksn, Department f Scilgy, University f Stckhlm, Sweden). 21 IV. Recmmandatins The participants t the meeting made recmmandatins n the varius research tpics regarding sci-ecnmic differential mrtality. 1. Recmmandatins n infant mrtality research Research shuld be carried ut, taking int accunt nt nly the father's ccupatin but als ther sensitive factrs such as mther's ccupatin, mther's age, birth weight...etc.... Under-reprting f deaths within the first days f life shuld be detected t ensure crrect measures. 2. Recmmandatins n the gegraphical apprach In a great number f cuntries, gegraphical mrtality differentials have been strngly evidenced. There is a need t deepen ur knwledge n the matter. In particular, attentin shuld be paid t the risk factrs generated by uncntrled industrializatin.

21 22 3. Recmmandatins cncerning cuntries where census-based prspective studies have nt been implemented In cuntries with limited data r limitatins due t cnfidentiality legislatin, research n sci-ecnmic differential mrtality shuld nt be drpped ut. On the cntrary, research prjects shuld be implemented, fcusing n the measurement f easily available sci-cnmic differentials and based n subgrups easily delimited: members f ld-age pensin schemes, emplyees f industrial crpratins, ppulatin f small gegraphical areas... etc.... Such prjects will pave the way in the future t brader studies using mre rigrus design. 4. Recmmandatins cncerning cuntries where census-based prspective studies have been implemented (a) Lngitudinal bservatin which is the basis f such studies shuld be expanded. The principle f lngitudinal bservatin is t gather fr each individual pieces f infrmatin frm varius surces and/r varius pints in time and t link them tgether. Lngitudinal bservatin shuld be cntinued and expanded since it is the best way t btain relevant measurement f mrtality differentials and trends in these differentials (see sessin reprt in II. 2) b) Methdlgy shuld be imprved and analysis enlarged, as cncerns the fllwing items: (i) By the time being, differentials in sci-ecnmic mrtality are mstly prvided by bservatin f deaths ccuring in the varius ccupatins, the ecnmically inactive peple being ften excluded frm bservatin. But there is a mrtality excess amng inactive peple vis-à-vis active peple f same ages. On the ther hand, a great number f peple die after they have retired frm the wrkfrce. Therefre, bservatin has t include inactive peple in rder t ensure accurate and exhaustive measurement f differentials in sci-ecnmic mrtality. (ii) By the time being, sci-ecnmic mrtality differentials are mstly studied n the basis f the individual's ccupatin and/r incme. Other criteria might be taken int accunt, wrk cnditin, husing cnditin, educatinal attainment, family... etc... They might thrw new light int the field. (iii) Every effrt shuld be deplyed t separate the impact f sci-ecnmic cnditin and that f sex n mrtality differentials. New criteria f scial classificatin shuld be sught t determine mre accurately sci-ecnmic differential mrtality amng females. In particular, there is a need t take int

22 accunt the varius perids f ccupatinal activity and inactivity in the female life cycle. (iv) Every effrt shuld be deplyed t assess mre clearly the relatinship between scial mbility, gegraphical mbility and mrtality differentials Recmmandatins fr data cmparability imprvement There is an urgent need t imprve the cmparability f data and findings. Internatinal bdies such as the Statistical Office f the Eurpean Ecnmic Cmmunities shuld be asked t persuade cuntries t harmnize their ccupatinal (r sci-ecnmic status) classificatins. In particular, gvernment agencies shuld be asked t hld data in a way which culd allw basic re-grupings cmmn t all industrialized cuntries. Members f the Netwrk shuld cntinue in the future t prvide CICRED with up-t-date classificatins as the ld classificatins are mdified. 6. Recmmandatins regarding disseminatin f findings Researchers shuld attempt t disseminate mre bradly their findings amng the decisin-makers and the public. They shuld try t disseminate mre quickly the methdlgical elements f their wrk amng fellw-researchers in ther cuntries. They shuld try als t indicate t their clleagues the varius risks f bias, f under-reprting... generated by their methdlgy, their way f ccupatins' re-gruping etc.... t avid misleading interpretatin.

23 24 ANNEX List f participating institutins Istitut di Ricerche sulla Pplazine (IRP), Cnsigli Nazinale delle Ricerche, Viale Beethven 56, Rme (Italy) Dipartiment di Scienze demgrafiche (DSD), Università di Rma «La Sapienza», Via Nmentana 41, Rme (Italy) ISTAT, Viale Liegi 13, Rme (Italy) Istitut Scienze Infrmazini, Università di Bari, Via Amendla 173, Rme (Italy) Università di Trin, Via Cappadcia 34, Rme (Italy) Università di Napli, P.zza Mattei 3, Rme (Italy) Osservatri Epidemilógic, Regine Lazi, Via R.R. Garibaldi 7, Rme (Italy) Dipartiment Statistic, Università di Firenze, Via Curtatne 1, Firenze (Italy) Università di Palerm, Via Giusti 21, Palerm (Italy) Università di Bari, V.le Kennedy 85, Bari (Italy) Antni Glini Agstin Lri Rssella Palmba Eugeni Snnin Nra Federici August Asclani Carla Bielli Graziella Caselli Anna De Sarn Viviana Egidi Giuseppe Gesan Dinisia Maffili Marcell Natale Annunziata Nbile Antnella Pinelli Givanni Cariani Alessandr De Simni Elvira Mallard Givanni Marrcchi Firella De Rsis Sergi Favilli Enz Lmbard Carl Perucci Carlina Tasc Antni Santini Silvana Salvini Silvana Schifini d'andréa Marzia Valli-Tdar Luigi Di Cmité

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