Cumulative deprivation and cause specific mortality.: A census based study of life course influences over three decades

Objective: To examine whether increasing cumulative deprivation has an incremental effect on total as well as cause specific mortality. Design: Census data on housing conditions as indicators of deprivation from 1960, 1970, and 1980 were linked to 1990 - 98 death registrations. Relative indices of inequalities were computed for housing conditions to measure the cumulative impact of differences in social conditions. Participants: 97 381 (71.1%) 30 - 49 year old and 70 701 (80.0%) 50 - 69 year old inhabitants of Oslo, Norway, in 1990 with census information on housing conditions and recorded length of education. Main results: Mortality risk was increased when all censuses' housing conditions were summed in both age groups and sex. The cause specific analysis indicated such an effect particularly for coronary heart disease, chronic obstructive lung disease, and smoking related cancers. Violent deaths were essentially associated with housing conditions closer to the time of death in men in both age groups and in young women. Conclusions: To fully account for socially mediated risk of death, a full life course approach should be adopted. The relative importance of each stage seems to vary by cause of death.