Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95

Study objective-To quantify the contribution of different causes of death and age groups for trends in life expectancy for two major social classes. Design and setting-Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was from the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was by computerised record linkage to death certificates for 1971-1995. Main results-From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women respectively, with largest gains among 55-74 year old men and 65-84 year old women. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. In the 1980s, when differences in life expectancy increased most rapidly, decline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associated causes, "other diseases", and accidents and violence were most prominent in the manual class. Conclusions-Explanations of increasing social inequalities in mortality that are based on one underlying factor are difficult to reconcile with the variability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.