Kunst AE, Mackenbach JP. International variation in the size of mortality differences associated with occupational status. International Journal of Epidemiology 1994; 23 (4): 742-50

Background. Previous international comparisons on the sire of mortality differences associated with occupational status have relied on inequality indices with one or more limitations. This study reassesses the international pattern of inequalities in mortality using an inequality index devised recently.
Methods, Data on mortality by social class were obtained from longitudinal studies from seven countries. The data referred to men aged 35-64 years. The follow-up period was approximately 1971-1981. The size of mortality differences associated with occupational status was measured using a modification of the Relative Index of inequality.
Results, The smallest inequalities in mortality are observed for Norway and Denmark. Larger inequalities are observed for Sweden (compared to Norway circa 1.5 times as large), England and Wales (2 times), Finland (4-5 times) and France (6-8 times). inequalities in a Dutch city, Rotterdam, are as large as in Danish and Swedish cities, and smaller than in Finnish and French cities. Results of sensitivity analyses suggest that probably only a small part of this international pattern can be attributed to differences between countries with respect to occupational classification.
Conclusions. The results of most previous international comparisons agree with the general pattern observed here. This simultaneous comparison of Various countries shows that the frequently cited difference between Sweden, and England and Wales is small when viewed in a wider international context.