Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95

Study objective-To quantify the contribution of different causes of death a nd age groups for trends in life expectancy for two major social classes. Design and setting-Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was f rom the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was b y computerised record linkage to death certificates for 1971-1995. Main results-From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women resp ectively, with largest gains among 55-74 year old men and 65-84 year old wo men. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. I n the 1980s, when differences in life expectancy increased most rapidly, de cline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associ ated causes, "other diseases", and accidents and violence were most promine nt in the manual class. Conclusions-Explanations of increasing social inequalities in mortality tha t are based on one underlying factor are difficult to reconcile with the va riability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.