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June 2004, Vol 94, No. 6 | American Journal of Public Health 1037-1042
© 2004 American Public Health Association

RESEARCH AND PRACTICE

All-Cause and Cause-Specific Mortality by Socioeconomic Status Among Employed Persons in 27 US States, 1984–1997

Kyle Steenland, PhD, Sherry Hu, MS and James Walker, PhD

Kyle Steenland is with the Department of Environmental and Occupational Health, Emory School of Public Health, Emory University, Atlanta, Ga. Sherry Hu is with the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta. James Walker is with the National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio.

Correspondence: Requests for reprints should be sent to Kyle Steenland, PhD, Professor, Dept of Environmental and Occupational Health, Rollins School of Public Health, 1518 Clifton Ave, Atlanta, GA 30322 (e-mail: nsteenl{at}sph.emory.edu).

Objectives. We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984–1997.

Methods. SES was determined for persons aged 35–64 years according to the "usual occupation" listed on their death certificates. We used US Census denominator data.

Results. For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997.

Conclusions. Mortality differences by SES were sustained through the 1990s and are increasing for men.




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