Comparing health inequality in men and women: prospective study of mortality 1986-96

Objectives To study prospectively the differences in health inequality in m en and women from 1986-96 using the Office for National Statistics' longitu dinal study and new socioeconomic classification. To assess the relative im portance of social class (based on employment characteristics) and social p osition according to the general social advantage of the household to morta lity risk in men and women. Design Prospective study. Setting England and Wales. Subjects Men and women of working age at the time of the 1981 census, with a recorded occupation. Main outcome measures Mortality. Results In men, social class based on employment relations, measured accord ing to the Office for National Statistics' socioeconomic classification, wa s the most important influence on mortality. In women, social class based o n individual employment relations and conditions showed only a weak gradien t Large differences in risk of mortality in women were found, however; when social position was measured according to the general social advantage in the household, Conclusions Comparisons of the extent of health inequality in men and women are affected by the measures of social inequality used. For women, even th ose in paid work, classifications based on characteristics of the employmen t situation may give a considerable underestimate. The Office for National Statistics' new measure of socioeconomic position is useful for assessing h ealth inequality in men, but in women a more important predictor of mortali ty is inequality in general social advantage of the household.