Inequalities in mortality according to educational level in two large Southern European cities

Background In Spain, studies on social inequalities in mortality based on i ndividuals are few due to the poor quality of information on occupation in death certificates. This study looks at the differences in mortality accord ing to educational level, using individual information obtained through the linkage between the Death Register and the Municipal Census, in the cities of Madrid and Barcelona, Spain. Methods The study populations were residents of Madrid and Barcelona aged > 24 years, who died in 1993 and 1994. Indicators obtained for each city and educational level were: age- and sex-specific mortality rates, and life exp ectancy at 25 years. Poisson regression models were fitted to obtain the re lative risk (RR) of death for each educational level with respect to the re ference level (higher education completed), adjusted for age. Results The mortality rate was lower among individuals with higher educatio nal levels, while life expectancy at 25 years was higher. In both cities me n and women with no education showed the highest mortality in all age group s, with very high RR in the youngest age group (RR for men aged 25-34 years = 7.08 in Madrid and 6.02 in Barcelona, whereas in women these RR were 6.3 3 and 5.63 respectively). In Barcelona the greater part of the overall mort ality difference for the group aged 25-34 years was due to AIDS (acquired d eficiency syndrome, 33.4% in men and 59.3% in women). Conclusion The present study has found higher mortality (mainly from AIDS) among individuals with no academic qualifications thus drawing attention to the need to implement policies aimed at reducing these inequalities.