Socioeconomic differentials in mortality among older people.

R esearch in social epidemiology and medical sociology has consistently shown that people in lower socioeconomic status groups experience poorer health and live shorter lives than those in higher status groups. However, investigations of such differentials among people aged 65 and over is still comparatively rare. In this issue of the journal Huisman et al report on the results of their analyses of socioeconomic status (housing tenure, education) and mortality among older people. These were based on data from mortality registries linked with population census data from 11 European countries and regions. Institutionalised populations were not included. Their results indicate that absolute and relative socioeconomic inequalities in mortality persisted into old age among men and women, and that relative socioeconomic inequalities in mortality were as great among older as middle aged people in some populations, although the age pattern of relative inequalities differed between populations by sex. However, an association between socioeconomic status and mortality was still present in the oldest age groups (90+). Their pooled data show that absolute socioeconomic mortality inequalities increased with age, while relative socioeconomic mortality inequalities generally decreased with age, although there were international variations in patterns. Overall, socioeconomic inequalities in relation to housing tenure were smaller than with education in the two oldest age groups. The authors conclude such inequalities are an important public health problem in Europe. The issue of socioeconomic inequalities in morbidity, as well as mortality, has attracted a large number of investigators, but comparatively few have focused on elderly populations. By including the very old age groups, the study by Huisman makes a significant contribution to the literature on inequalities and mortality, and emphasises the importance of considering older people in public health policy and actions. It is a topic of increasing importance given the aging populations in developed countries, and increases in life expectancy, and given that most people who die and who are in poor health are aged over 60.