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January 6, 2003


Emory Study Links Risks of Death from Injury to Socioeconomic Status

ATLANTA -- Being a blue collar worker such as a trash collector or a maid, rather than a white collar professional such as a teacher or lawyer, doubles a person's odds of dying from violent injury, says a new study that analyzes causes of death and employment categories for more than a quarter-million Americans. And the effect is even stronger for men than it is for women.

The findings of Kyle Steenland, PhD, professor of environmental and occupational health at Emory Universityís Rollins School of Public Health, and colleague s from the National Institute for Occupational Safety and Health and New Jersey Medical School were published in the January issue of the Epidemiology journal.

Dr. Steenland used occupational mortality data from death certificates in a program coordinated by the National Institute for Occupational Safety and Health and data from the US Census to estimate the association between socioeconomic status and deaths from external causes, which includes motor vehicle accidents, suicide, homicide, medical complications, and non-vehicular injuries. For both men and women aged 20 to 64, all major categories of death from these external causes are related to socioeconomic status (SES). The results show a strong trend of fewer deaths with higher socioeconomic status and higher deaths with lower socioeconomic status.

"Deaths from external causes are usually preventable and are the second leading cause of years of life lost for persons under age 75, just behind cancer," Dr. Steenland says. "We show that these causes are strongly related to socioeconomic status. Those in the lower quarter of socioeconomic status die at a rate twice that of those in the upper quarter of socio-economic status."

A total of 261,723 deaths were measured in 27 states from 1984-1997 among employed persons aged 20-64. Occupations were determined by listings on death certificates and Nam-Powers scores were used to measure socioeconomic status. (Nam-Power scores are well-known and commonly used scores based on the income and education levels associated with each occupation enumerated in the U.S. census.)

The scores were then divided into four quartiles, with the first quartile representing the lowest socioeconomic status and the fourth quartile the highest socioeconomic status. *

For men and women combined, 40% of motor vehicle fatalities can be attributed to being in the lower 3/4 of SES versus the top quartile SES. In addition, 32% of suicides, 51% of homicides and 40% of deaths from other injuries can be attributed to having an SES status below the top quartile.

"Approximately 41% of the measured deaths would be preventable if those in the lowest three quartiles of socioeconomic status had the same income and education as those in the top quartile of socioeconomic status," Dr. Steenland says. "But there are lots of reasons why the less advantaged die more of external causes ≠ less access to mental health care, unsafe working and living conditions, and more exposure to violent crime. All these factors can be improved if society as a whole wishes to make these changes."

The data reflect a stronger and more consistent SES effect among males than females. Males had a three to four times higher death rate due to external causes than females. Dr. Steenland suggests that the factors that increase deaths from external causes in men, such as higher rates or alcohol abuse, higher crime rates, and more work-related fatalities, are factors associated with SES. Dr. Steenlandís research also concluded that:
  • Men in the lowest quartile had a mortality rate from external causes almost three times higher than men in the highest quartile.
  • Women in the lowest quartile had 58% higher rate of mortality than women in the highest quartile.
  • Blacks had a 74% higher rate of death from all external causes when compared to whites.
  • Homicide rates in the data in the entire U.S. began decreasing in the 1990s, parallel with an improving U.S. economy, and parallel to a decrease in all serious crime.

"Often we in the scientific and medical community focus on details of one disease or one treatment, failing to look at the big picture," Dr. Steenland says. "Facing up to inequalities in death rates may force us to see the dramatic impact of inequalities in our daily lives."

N. Kyle Steenland, Ph.D. conducts research in occupational and environmental epidemiology. Dr. Steenland also works on issues of epidemiologic methods and risk assessment. Recently he has begun new work in the area of social epidemiology, studying the relation of socioeconomic status to cancer and heart disease.

*Examples of occupations in each socioeconomic quartile include: first quartile- maids, roofers, garbage collectors; second quartile - bartender, truck driver, carpenter, auto mechanic; third quartile- postal clerk, secretary, car salesman; fourth quartile - registered nurse, elementary teacher, lawyer, doctor


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