Premature Cardiovascular Mortality in France: Divergent Evolution between Social Categories from 1970 to 1990

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Abstract
Background. In France, differences in cardiovascular risk factor distribution have been observed which might be responsible for some disparities in cardiovascular mortality between social categories. The goal of the study was thus to assess the differences in coronary heart disease (CHD) and cerebrovascular diseases (CVD) mortality according to social category, and to determine their trends over the last 20 years in France. Methods. Mortality data for CHD, CVD, diseases of the circulatory system (CS) and all causes mortality (TM) were based on death certificates for 1970, 1980 and 1990, and categorized by sex, age group (35–44 and 45–54 years), region and social category. Results. Among active men, from 1970 to 1990, the overall decrease observed for all causes of death was significantly slower among employees and workers for CHD, CS and TM (P Conclusions. In men, the inequalities have increased over the last two decades for CHD and have not been reduced for CVD. The category of employees and workers were found to be at special risk for premature cardiovascular disease mortality. Among women, the trends were less clear, although the tendencies were the same. An increasing disparity between active and non-active people suggests that a health-related selection process towards unemployment might have contributed to the decreasing mortality rates observed among employees and workers.

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