Social inequality and environmentally-related diseases in Germany: Review of empirical results

A literature search was conducted aiming at all empirical studies from Germ any till mid 1997 containing data on the association between environmentall y-relate diseases and the socio-economic status (education, occupation, inc ome, social class) and/or on the association between the exposure to harmfu l substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to t he lower social class as compared with the higher social class. This applie s to children as well as to adults and to West Germany as well as to East G ermany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that a llergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kid ney cancer or bladder cancer), however, seem to occur more frequently in th e lower social class than in the higher social class. Environmental-epidemi ological studies should increasingly integrate socio-epidemiological study approaches and explicitly present their results.