• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jepicomhInstructions for authorsCurrent TOCJournal of Epidemiology and Community Health
J Epidemiol Community Health. Dec 2003; 57(12): 974–980.
PMCID: PMC1732354

Gender differences in socioeconomic inequality in mortality


Objectives: There is uncertainty about whether position in a socioeconomic hierarchy confers different mortality risks on men and women. The objective of this study was to conduct a systematic review of gender differences in socioeconomic inequality in risk of death.

Methods: This research systematically reviewed observational cohort studies describing all cause or cause specific mortality for populations aged 25–64 in developed countries. For inclusion in the review, mortality had to be reported stratified by gender and by one or more measures of socioeconomic status. For all eligible studies, five absolute and six relative measures of the socioeconomic inequality in mortality were computed for male and female populations separately.

Results: A total of 136 published papers were reviewed for eligibility, with 58 studies deemed eligible for inclusion. Of these eligible studies, 20 papers published data that permitted the computation of both absolute and relative measures of inequality. Absolute measures of socioeconomic mortality inequality for men and women generally agreed, with about 90% of studies indicating that male mortality was more unequal than female mortality across socioeconomic groups. In contrast, the pattern of relative inequality results across the 20 studies suggested that male and female socioeconomic inequality in mortality was equivalent.

Conclusions: Inferences about gender differences in socioeconomic inequality in mortality are sensitive to the choice of inequality measure. Wider understanding of this methodological issue would improve the clarity of the reporting and synthesis of evidence on the magnitude of health inequalities in populations.

Full Text

The Full Text of this article is available as a PDF (268K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Koskinen S, Martelin T. Why are socioeconomic mortality differences smaller among women than among men? Soc Sci Med. 1994 May;38(10):1385–1396. [PubMed]
  • McDonough P, Williams DR, House JS, Duncan GJ. Gender and the socioeconomic gradient in mortality. J Health Soc Behav. 1999 Mar;40(1):17–31. [PubMed]
  • Vâgerö D. Health inequalities in women and men. BMJ. 2000 May 13;320(7245):1286–1287. [PMC free article] [PubMed]
  • Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378. [PubMed]
  • Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997 Mar;44(6):757–771. [PubMed]
  • Manor O, Matthews S, Power C. Comparing measures of health inequality. Soc Sci Med. 1997 Sep;45(5):761–771. [PubMed]
  • Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557. [PubMed]
  • Kaufman JS, Long AE, Liao Y, Cooper RS, McGee DL. The relation between income and mortality in U.S. blacks and whites. Epidemiology. 1998 Mar;9(2):147–155. [PubMed]
  • Markides KS. Consequences of gender differentials in life expectancy for black and Hispanic Americans. Int J Aging Hum Dev. 1989;29(2):95–102. [PubMed]
  • Park KA, Clifford WB. Sex differentials in cardiovascular mortality: an ecological analysis. Soc Sci Med. 1989;29(7):869–876. [PubMed]
  • Wingard DL, Suarez L, Barrett-Connor E. The sex differential in mortality from all causes and ischemic heart disease. Am J Epidemiol. 1983 Feb;117(2):165–172. [PubMed]
  • Wunsch G, Duchene J, Thiltges E, Salhi M. Socio-economic differences in mortality. A life course approach. Eur J Popul. 1996 Jun;12(2):167–185. [PubMed]
  • Wilkins R, Adams O, Brancker A. Changes in mortality by income in urban Canada from 1971 to 1986. Health Rep. 1989;1(2):137–174. [PubMed]
  • Goldblatt P, Fox J, Leon D. Mortality of employed men and women. Am J Ind Med. 1991;20(3):285–306. [PubMed]
  • Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health. 1995 Jul;85(7):949–956. [PMC free article] [PubMed]
  • Feldman JJ, Makuc DM, Kleinman JC, Cornoni-Huntley J. National trends in educational differentials in mortality. Am J Epidemiol. 1989 May;129(5):919–933. [PubMed]
  • Elo IT, Preston SH. Educational differentials in mortality: United States, 1979-85. Soc Sci Med. 1996 Jan;42(1):47–57. [PubMed]
  • Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. [PubMed]
  • Millar WJ. Sex differentials in mortality by income level in urban Canada. Can J Public Health. 1983 Sep-Oct;74(5):329–334. [PubMed]
  • Pamuk ER. Social class inequality in mortality from 1921 to 1972 in England and Wales. Popul Stud (Camb) 1985 Mar;39(1):17–31. [PubMed]
  • Anderson RT, Sorlie P, Backlund E, Johnson N, Kaplan GA. Mortality effects of community socioeconomic status. Epidemiology. 1997 Jan;8(1):42–47. [PubMed]
  • Sundquist J, Johansson SE. Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39,156 people in Sweden. J Epidemiol Community Health. 1997 Feb;51(1):35–40. [PMC free article] [PubMed]
  • Koskenvuo M, Kaprio J, Kesäniemi A, Sarna S. Differences in mortality from ischemic heart disease by marital status and social class. J Chronic Dis. 1980;33(2):95–106. [PubMed]
  • Backlund E, Sorlie PD, Johnson NJ. The shape of the relationship between income and mortality in the United States. Evidence from the National Longitudinal Mortality Study. Ann Epidemiol. 1996 Jan;6(1):12–22. [PubMed]
  • Smith KR, Waitzman NJ. Effects of marital status on the risk of mortality in poor and non-poor neighborhoods. Ann Epidemiol. 1997 Jul;7(5):343–349. [PubMed]
  • Olausson PO. Mortality among the elderly in Sweden by social class. Soc Sci Med. 1991;32(4):437–440. [PubMed]
  • Wing S, Dargent-Molina P, Casper M, Riggan W, Hayes CG, Tyroler HA. Changing association between community occupational structure and ischaemic heart disease mortality in the United States. Lancet. 1987 Nov 7;2(8567):1067–1070. [PubMed]
  • McLoone P, Boddy FA. Deprivation and mortality in Scotland, 1981 and 1991. BMJ. 1994 Dec 3;309(6967):1465–1470. [PMC free article] [PubMed]
  • Luoto R, Prättälä R, Uutela A, Puska P. Impact of unhealthy behaviors on cardiovascular mortality in Finland, 1978-1993. Prev Med. 1998 Jan-Feb;27(1):93–100. [PubMed]
  • Koskenvuo M, Sarna S, Kaprio J, Lönnqvist J. Cause-specific mortality by marital status and social class in Finland during 1969--1971. Soc Sci Med Med Psychol Med Sociol. 1979 Nov;13A(6):691–697. [PubMed]
  • Morris JN, Blane DB, White IR. Levels of mortality, education, and social conditions in the 107 local education authority areas of England. J Epidemiol Community Health. 1996 Feb;50(1):15–17. [PMC free article] [PubMed]
  • Martelin T. Mortality by indicators of socioeconomic status among the Finnish elderly. Soc Sci Med. 1994 May;38(9):1257–1278. [PubMed]
  • Gregorio DI, Walsh SJ, Paturzo D. The effects of occupation-based social position on mortality in a large American cohort. Am J Public Health. 1997 Sep;87(9):1472–1475. [PMC free article] [PubMed]
  • Hemström O. Does the work environment contribute to excess male mortality? Soc Sci Med. 1999 Oct;49(7):879–894. [PubMed]
  • Pekkanen J, Tuomilehto J, Uutela A, Vartiainen E, Nissinen A. Social class, health behaviour, and mortality among men and women in eastern Finland. BMJ. 1995 Sep 2;311(7005):589–593. [PMC free article] [PubMed]
  • Backlund E, Sorlie PD, Johnson NJ. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Soc Sci Med. 1999 Nov;49(10):1373–1384. [PubMed]
  • Waldron I. The contribution of smoking to sex differences in mortality. Public Health Rep. 1986 Mar-Apr;101(2):163–173. [PMC free article] [PubMed]
  • Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979 Feb;109(2):186–204. [PubMed]
  • Orth-Gomér K, Johnson JV. Social network interaction and mortality. A six year follow-up study of a random sample of the Swedish population. J Chronic Dis. 1987;40(10):949–957. [PubMed]
  • Blazer DG. Social support and mortality in an elderly community population. Am J Epidemiol. 1982 May;115(5):684–694. [PubMed]
  • House JS, Robbins C, Metzner HL. The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study. Am J Epidemiol. 1982 Jul;116(1):123–140. [PubMed]
  • Kaplan GA, Salonen JT, Cohen RD, Brand RJ, Syme SL, Puska P. Social connections and mortality from all causes and from cardiovascular disease: prospective evidence from eastern Finland. Am J Epidemiol. 1988 Aug;128(2):370–380. [PubMed]
  • Mäkelä P, Valkonen T, Martelin T. Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study. BMJ. 1997 Jul 26;315(7102):211–216. [PMC free article] [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...