Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?

Background Cause-specific information on sodoeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making. Methods Mortality data of the under 65 age group in The Hague were analysed (1982-1991) at residential area level. Results Causes of death with a high socioeconomic gradient among males were : homicide, chronic liver disease, 'other' external causes of injury, diabe tes, bronchitis, emphysema and asthma, and motor vehicle accidents: and amo ng females: diabetes, ischaemic heart disease. 'other' diseases of the circ ulatory system, signs, symptoms and ill-defined conditions, malignant neopl asm of cervix, and 'other' diseases. Main contributors to the mortality dif ferences between the highest and lowest socioeconomic quartiles among males were: ischaemic heart disease (17.3%), 'other' diseases of the circulatory system (10.2%), signs, symptoms and ill-defined conditions (9.0%), 'other' external causes of injury (8.6%), and chronic liver disease (7.2%); and am ong females: ischaemic heart disease (25.5%), 'other' diseases (20.1%), sig ns, symptoms and ill-defined conditions (18.6%),'other' diseases of the cir culatory system (11.0%), and diabetes (9.1%). Among females the contributio ns of malignant neoplasms of breast (-16.3%) and colon (-5.5%) and suicide (-4.3%) were negative. Conclusions The diseases that are the main contributors to urban socioecono mic mortality differences can be influenced by public health policy.