Education inequalities in adult all-cause mortality: first national data for Australia using linked census and mortality data

Abstract

Background National linked mortality and census data have not previously been available for Australia. We estimated education-based mortality inequalities from linked census and mortality data that are suitable for international comparisons. Methods We used the Australian Bureau of Statistics Death Registrations to Census file, with data on deaths (2011–2012) linked probabilistically to census data (linkage rate 81%). To assess validity, we compared mortality rates by age group (25–44, 45–64, 65–84 years), sex and area-inequality measures to those based on complete death registration data. We used negative binomial regression to quantify inequalities in all-cause mortality in relation to five levels of education [‘Bachelor degree or higher’ (highest) to ‘no Year 12 and no post-secondary qualification’ (lowest)], separately by sex and age group, adjusting for single year of age and correcting for linkage bias and missing education data. Results Mortality rates and area-based inequality estimates were comparable to published national estimates. Men aged 25–84 years with the lowest education had age-adjusted mortality rates 2.20 [95% confidence interval (CI): 2.08‒2.33] times those of men with the highest education. Among women, the rate ratio was 1.64 (1.55‒1.74). Rate ratios were 3.87 (3.38‒4.44) in men and 2.57 (2.15‒3.07) in women aged 25–44 years, decreasing to 1.68 (1.60‒1.76) in men and 1.44 (1.36‒1.53) in women aged 65–84 years. Absolute education inequalities increased with age. One in three to four deaths (31%) was associated with less than Bachelor level education. Conclusions These linked national data enabled valid estimates of education inequality in mortality suitable for international comparisons. The magnitude of relative inequality is substantial and similar to that reported for other high-income countries.

Education-related inequalities in cause-specific mortality: First estimates for Australia using individual-level linked census and mortality data

“…Compared with the most recent national estimates of inequalities (for the period 2009-11) using area-level measures of SEP, our education-based inequality estimates are substantially larger for all-cause and cause-specific mortality ( 11 ). Our estimates are also higher than but consistent with previous estimates of education-related inequalities reported for all-cause ( 6 ) and selected causes of death ( 26 ) in Australia for 2011-12. These differences likely reflect, at last in part, methodological differences, as well as changes in the composition of educational groups over time (Supplementary 5).…”

“…The RRs presented in this study are generally larger in magnitude than those reported for other high-income countries ( 8, 9, 27-29 ). However, similar estimates have been reported in other advanced welfare states ( 6, 2, 7, 28 ). In Norway, education-related mortality RRs for men in causes amenable to behaviour change were greater than three for the population aged 30-79, and were greater than two for causes amenable to medical intervention ( 8 ).…”

“…Death rates in high-income countries, including Australia, have decreased substantially over recent decades (1), but clear inverse socioeconomic gradients in mortality persist (2)(3)(4)(5)(6). Understanding the reasons for these inequalities, including identifying causes of death with the largest contribution to these differences, is crucial for informing strategies to reduce health inequalities and improve the overall health of the population.…”

Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study

“…We derived highest level of education from two self-reported census variables: highest year of secondary school completed and highest non-school qualification. Consistent with OECD recommendations and in line with previous Australian research describing mortality inequalities according to education level [ 7 , 16 ], we created five mutually exclusive categories. These were: university qualification, irrespective of whether Year 12 was completed (highest education level); other post-secondary school qualification and completed Year 12; other post-secondary school qualification but did not complete Year 12; no post-secondary school qualification but completed Year 12; and, no post-secondary school qualification and did not complete Year 12 (lowest education level).…”

Inequalities in life expectancy in Australia according to education level: A whole-of-population record linkage study

“…One of the most prominent forms of health inequality relates to an individual's socioeconomic position, with well documented inequalities evident in numerous health indicators [4,5], including mortality [6,7]. Yet, there are no contemporary estimates of socioeconomic gaps in life expectancy for Australia.…”