Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997

Lillian Hayes

Sirs—It is interesting to note that Turrell and Mathers, in their article ‘Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997' reported that the excess mortality associated with socioeconomic disadvantage of area was greater for females than males.

When one examines the tables, the excess mortality for males in Table 3 seems to be in accordance with the figures in Table 2. The 1995–1997 results are used to demonstrate this. Excess all-cause male mortality of 22%, 28% and 26% in the respective three age groups (Table 3) is in accordance with the rate ratios of 1.62, 1.78 and 1.64, and the Gini coefficients of 0.09, 0.10 and 0.09 (Table 2). However, for the same period the reported higher excess all-cause female mortality of 35%, 70% and 56% does not appear to be in accordance with the lower rate ratios of 1.45, 1.40 and 1.45 and the Gini coefficients of 0.07, 0.07 and 0.07.

Given the reported gradient across quintiles and the values presented in Table 1 one may interpolate values for Q2 and Q4 and hence estimate rate ratios, Gini coefficients and excess mortality. All-cause rate ratios and Gini coefficients, for both males and females and excess all-cause mortality for males derived using these approximations are very similar to those presented by Turrell and Mathers. However for females, excess all-cause mortality (19%, 18% and 20%) thus derived are considerably lower than the values reported by Turrell and Mathers (35%, 70% and 56%) and lower than the male values as would be expected from the lower rate ratios.


 

Author's response

Gavin Turrell and Colin Mathers

Sirs—In our paper ‘Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1997' (Int J Epidemiol 2001;30:221–39) the excess mortality figures for females were incorrect (Table 3). This error, which was kindly reported by Dr Lillian Hayes in her letter to the Journal, has now been corrected, and the amended figures appear in the tableGo overleaf. The excess mortality figures estimate the percentage of deaths for females in each age group that potentially could be avoided if all quintiles had the same age-standardized mortality rate as the least disadvantaged quintile (Q1). In short, the figures estimate the burden of mortality in the Australian population that is attributable to socioeconomic disadvantage. The corrected estimates of excess mortality for females suggests that substantial reductions in overall mortality would occur if all quintiles had a death rate equivalent to that of the most advantaged quintile. For females aged 0–14 in 1995–1997, this ranged from 10% for perinatal conditions to 54% for SIDS. For females aged 15–24 during the same period, the potential reductions were in the range 15% for all causes to 33% for motor vehicle traffic accident, and for those aged 25–64 potential reductions ranged from 8% for cancer (all types) to 52% for diabetes mellitus.


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Table Excess mortalitya by socioeconomic disadvantage of area, 1985–1987 and 1995–1997
 
We again thank Dr Hayes for identifying this error, thus providing us with an opportunity to present the corrected estimates (all other data and figures were checked and found to be correct). We hope that our oversight caused minimal inconvenience to the readers of the Journal.





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