EDUCATION AND OCCUPATIONAL SOCIAL-CLASS - WHICH IS THE MORE IMPORTANTINDICATOR OF MORTALITY RISK

Study objectives-In the UK, studies of socioeconomic differentials in mortality have generally relied upon occupational social class as the index of socioeconomic position, while in the US, measures based upon education have been widely used. These two measures have different cha racteristics; for example, social class can change throughout adult li fe, while education is unlikely to alter after early adulthood. Theref ore different interpretations can be given to the mortality differenti als that are seen. The objective of this analysis is to demonstrate th e profile of mortality differentials, and the factors underlying these differentials, which are associated with the two socioeconomic measur es. Design-Prospective observational study. Setting-27 work places in the west of Scotland. Participants-5749 men aged 35-64 who completed q uestionnaires and were examined between 1970 and 1973. Findings-At bas eline, similar gradients between socioeconomic position and blood pres sure, height, lung function, and smoking behaviour were seen, regardle ss of whether the education or social class measure was used. Manual s ocial class and early termination of full time education were associat ed with higher blood pressure, shorter height, poorer lung function, a nd a higher prevalence smoking. Within education strata, graded associ ation between smoking and social strong, whereas within groups the rel ation between education and smoking is attenuated. Over 21 years of fo llow up, 1639 of the men died. Mortality from all causes and from thre e broad cause of death groups (cardiovascular disease, malignant disea se, and other causes) showed similar associations with social class an d education. For all cause of death groups, men in manual social class es and men who terminated full time education at an early age had high er death rates. Cardiovascular disease was the cause of death group mo st strongly associated with education, while the non-cardiovascular no n-cancer category was the cause of death group most strongly associate d with adulthood social class. The graded association between social c lass and all cause mortality remains strong and significant within edu cation strata, whereas within social class strata the relation between education and mortality is less clear. Conclusions-As a single indica tor of socioeconomic position occupational social class in adulthood i s a better discriminator of socioeconomic differentials in mortality a nd smoking behaviour than is education. This argues against interpreta tions that see cultural-rather than material-resources as being the ke y determinants of socioeconomic differentials in health. The stronger association of education with death from cardiovascular causes than wi th other causes of death may reflect the function of education as an i ndex of socioeconomic circumstances in early life, which appear to hav e a particular influence on the risk of cardiovascular disease.