Occupational class and ischemic heart disease mortality in the United States and 11 European countries

Objectives. Twelve countries were compared with respect to occupational cla ss differences in ischemic heart disease mortality in order to identify fac tors that are associated with smaller or larger mortality differences. Methods. Data on mortality by occupational class among men aged 30 to 64 ye ars were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countrie s. Potential effects of the main data problems were evaluated quantitativel y. Results. A north-south contrast existed within Europe. In England and Wales , Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries , manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as lar ge (among men aged 45-64 years). Conclusions. The results underline the highly variable nature of socioecono mic inequalities in ischemic heart disease mortality. These inequalities ap pear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeco nomic developments.