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This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.

This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.

BACKGROUND While it is widely known that maternal age at childbearing plays a role in the occurrence of Down syndrome, less is known about the effects of maternal age on other major congenital anomalies. Information on the possible effects of other maternal characteristics and of the age of the father is even scarcer. OBJECTIVE We present new results on the associations between parental ages and other maternal characteristics on the one hand, and congenital anomalies on the other, using linked data from three Czech registries on mothers, newborns, and malformations, for the period 2000-2007. METHODS As the variables are in a categorical format, binary logistic regression is used in order to investigate the relationship between the presence/absence of a congenital anomaly for each of the 11 types of anomalies considered, and for the set of predictors. RESULTS This research confirms that the age of the mother has an impact on the incidence of Down syndrome and other chromosomal anomalies. Paternal age is not associated with chromosomal anomalies, and, in this Czech population, has a rather slight effect on some of the congenital anomalies examined. Another finding of the present study is that various other maternal characteristics may affect the incidence of congenital malformations. CONCLUSIONS Based on a large dataset, this study concludes that the ages of both parents can be associated with congenital anomalies of the child, and that maternal characteristics other than age have also to be considered. COMMENTS Risk factors can be tentatively proposed if they are based on a plausible and suitably tested explanatory mechanism. Unfortunately, in the majority of individual cases of congenital anomaly, the cause of the condition is unknown, and is suspected to result from an interaction of multiple environmental and genetic factors. © 2013 Jitka Rychtařikova et al.

Background The magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations was compared, and the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe was determined. Methods Mortality data were obtained for people aged 30-64 years. For each country, the association between level of education and avoidable mortality was measured with the use of regression-based inequality indexes. Life table analysis was used to calculate the contribution of avoidable causes of death to inequalities in life expectancy between lower and higher educated groups. Results Educational inequalities in avoidable mortality were present in all countries of Europe and in all types of avoidable causes of death. Especially large educational inequalities were found for infectious diseases and conditions that require acute care in all countries of Europe. Inequalities were larger in Central Eastern European (CEE) and Baltic countries, followed by Northern and Western European countries, and smallest in the Southern European regions. This geographic pattern was present in almost all types of avoidable causes of death. Avoidable mortality contributed between 11 and 24% to the inequalities in Partial Life Expectancy between higher and lower educated groups. Infectious diseases and cardiorespiratory conditions were the main contributors to this difference. Conclusions Inequalities in avoidable mortality were present in all European countries, but were especially pronounced in CEE and Baltic countries. These educational inequalities point to an important role for healthcare services in reducing inequalities in health.

AIMS/HYPOTHESIS: The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. METHODS: We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. RESULTS: In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). CONCLUSIONS/INTERPRETATION: In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved

International audience; Objectives : To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders.Methods : Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and ‘gender × educational rank’.Results : An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0–3.9) in men versus 4.8 (95 % CI 3.2–7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated.Conclusions : Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.

Previous research has shown an association between paternal age and neonatal mortality controlling for age of mother and other confounding factors. As this association is possibly of a biological nature, one would also expect to find a significant relationship between paternal age and foetal mortality, stillbirth in particular. The present research is based on a Czech individual data set for the period 1986-1990. The risk of stillbirth is examined using logistic regression, taking account of both parental ages, sex of the foetus, birth order, prematurity, and education of parents. It is shown that, in this data set, there is a significant relation between age of father and risk of stillbirth.

Using data for 555,038 pregnancies conceived in the Czech Republic in 1987-1990, we show that pronounced differences in fetal survival in the middle trimester of pregnancy by marital status, educational level, and labor force attachment become much smaller at full term; survival differences by age at conception and number of previous deliveries show relatively constant proportional hazards throughout gestation. Social inequalities in postpartum life chances have been documented previously, but we show that similar inequalities exist before birth.

Background Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.

Rychtaříkova (Jitka), Dzúrová (Dagmar).- Geographical differentials in Czechoslovak mortality rates In the Czech Republic, the lowest mortality rates are found in Southern Moravia, the northern part of Southern Bohemia, and the border between Eastern Bohemia and Moravia. In the Slovak Republic, low mortality rates are found in two regions: an industrial region of Western Slovakia, and a poorly developed, rural region in the northern part of Eastern Slovakia. Differentials are largest in infant mortality and in mortality rates after the age of 60. In the Czech Republic, infant mortality rates are rather low, and rates over the age of 60 high: the opposite is true of Slovakia. Deaths from circulatory diseases and tumours are more frequent in the Czech Republic than in Slovakia, where there is a relative excess mortality from diseases of the respiratory system and the digestive tract. The influence of social conditions on mortality is clearly apparent, particularly in the signifiant Gypsy minority, or in cases where divorce rates are high. The part played by ecological variables in less clear., Rychtaríková (Jitka), Dzúrová (Dagmar).- Les disparités géographiques de la mortalité en Tchécoslovaquie Dans la République tchèque les districts les plus favorisés se trouvent en Moravie du Sud, dans la partie septentrionale de la Bohême du Sud et dans la partie de la Bohême de l'Est avoisinant la Moravie; dans la République slovaque, deux régions à mortalité basse apparaissent, l'une industrielle en Slovaquie occidentale et l'autre agricole peu développée dans la partie septentrionale de la Slovaquie de l'Est. La mortalité infantile et la mortalité après 60 ans présentent les plus grandes différences spatiales. En République tchèque, la mortalité infantile est plutôt basse et la mortalité au-delà de 60 ans élevée, l'inverse est vrai pour la Slovaquie. Les décès dus aux maladies de l'appareil circulatoire et aux tumeurs sont plus fréquents en République tchèque qu'en Slovaquie, où il existe une surmortalité relative due aux maladies des appareils respiratoire et digestif. L'influence des variables sociales sur la mortalité est nette, particulièrement en cas de présence d'une forte minorité tzigane ou de divortialité élevée. Le rôle joué par les variables écologiques est moins évident., Rychtaříkova (Jitka), Dzúrová (Dagmar).- Las disparidades geográfícas de la morta- lidad en Checoslovaquia En la República Checa los distritos más favorizados se encuentran en Moravia del Sud, en la parte septentrional de la Bohemia del Sud, y en la parte de la Bohemia del Este que limita con Moravia ; en la República Eslovaca, aparecen dos regiones de baja mortalidad, una industrial en Eslovaquia Occidental y la otra agricola poco desarrollada en la parte septentrional de la Eslovaquia del Este. La mortalidad infantil y la mortalidad pasados los 60 aňos, presentan las más grandes diferencias espaciales. En la República Checa, la mortalidad infantil es más bien baja y la mortalidad pasasdos los 60 aňos elevada, lo contrario es constatado para Eslovaquia. Las defunciones a causa de enfermedades del aparato circulatorio y a tumores son más frecuentes en la República Checa que en Eslovaquia, donde existe una sobremortalidad relativa debido a enfermedades de los aparatos respiratorio y digestivo. La influencia de las variables sociales sobre la mortalidad es neta, particularmente en el caso de la presencia de una considerable minoría gitana o de una elevada divorcialidad. El rol desempeňado por las variables ecológicas es menos évidente., Rychtarikova Jitka, Dzúrová Dagmar. Les disparités géographiques de la mortalité en Tchécoslovaquie. In: Population, 47ᵉ année, n°3, 1992. pp. 617-643.

Monnier Alain, Rychtarikova Jitka. - How Europe was Divided into East and West. During the last 40 years, European demography has been characterized by a dual movement. Generally, demographic trends have tended to converge, but differences in demographic behaviour have remained, and new ones have appeared. Demographic changes in Eastern Europe must be studied in the context of this considerable change in the European demographic landscape. Convergence towards a single European regime is illustrated by comparing movement in mortality and fertility. Although Europe to-day is more homogeneous demographically, the difference between Eastern European countries and others, though small, is very noticeable. An examination of changes in the main demographic indices relating to the constitution of the family (period nuptiality rates, divorces, births outside marriage) shows how from the middle 1960s onwards, behaviour in this field has become more alike within the countries of Eastern Europe, whilst at the same time differing from the situation in the West. But even within Western Europe there are some features specific to individual countries. In particular, the situation in Southern European countries is sui generis. Mortality in Eastern Europe, too, has begun to drift since the 1960s. The struggle against high death rates has tended to stagnate, whereas in other European countries considerable progress has been achieved since the late 1970s. A study of causes of death shows the difference between Eastern and Western European countries, but also points to significant differences within Eastern Europe. The West has become homogeneous, the East less so. Eastern Europe to-day appears different. However, neither the East nor the West constitute homogeneous demographic areas., Monnier Alain, Rychtarikov^ Jitka. - Comment l'Europe s'est divisée entre l'Est et l'Ouest. Au cours des quarante dernières années la démographie européenne a été marquée par un double mouvement. D'une façon générale, les dynamiques démographiques ont tendu à converger, mais en même temps, des différences de comportement persistent, ou même ont fait leur apparition. C'est dans ce vaste mouvement de recomposition du «paysage» démographique européen que doit être étudiée l'évolution démographique en Europe de l'Est. La convergence vers un même régime démographique est illustrée par la mise en parallèle de l'évolution de la mortalité et de la fécondité. Aujourd'hui, l'Europe est plus homogène, mais la différence d'ensemble des pays d'Europe de l'Est, par rapport aux autres pays, tout en demeurant modeste, n'a jamais été aussi évidente. L'examen de l'évolution des principaux indicateurs relatifs aux modes de constitution de la famille (indices synthétiques de nuptialité des célibataires et de divortialité, proportion de naissances hors mariage) montre comment les comportements familiaux ont tendu à se rapprocher dans les pays d'Europe de l'Est et à se différencier, par rapport au reste de l'Europe («l'Europe de l'Ouest») à partir du milieu des années 1960. Mais au sein même des pays d'Europe de l'Ouest, les évolutions qui se sont effectuées depuis une vingtaine d'années ont entraîné l'apparition d'autres particularismes. En particulier, les pays du sud de l'Europe se caractérisent aujourd'hui par une situation relativement originale. C'est aussi à partir du milieu des années 1960 que l'évolution de la mortalité accuse une certaine «dérive» dans les pays d'Europe de l'Est, où la lutte contre la mortalité stagne, alors qu'elle enregistre des progrès sensibles, notamment à partir de la fin des années 1970, dans tous les autres pays. L'examen des principales causes de décès montre comment, dans ce mouvement, les pays d'Europe de l'Est, tout en se différenciant de l'Europe de l'Ouest, ont vu s'accuser les différences qu'ils présentent entre eux : en quelque sorte, il y a eu unification à l'Ouest, division à l'Est. L'Europe de l'Est apparaît aujourd'hui différente. Pour autant, ni l'Est ni l'Ouest de l'Europe ne constituent des entités homogènes., Monnœr Alain, Rychtarikova Jitka. - i Cómo se dividió Europa, en Este y Oeste ?. En el transcurso de los últimos cuarenta afios, la demograffa europea estuvo marcada por un doble movimiento. De manera general, las dinámicas demográficas tendieron a converger, pero al mismo tiempo, las diferencias de comportamiento persisten, o incluso hicieron su aparición. Es en ése vasto movimiento de recomposition del «paisage» demográfico de Europa, que debe ser estudiada la evolution demográfica en Europa del Este. La convergencia hacia un mismo régimen demográfico esta ilustrado por la puesta en paralelo, de la evolution de la mortalidad y de la fecundidad. Hoy en dia, Europa es más homogenea, pero la diferencia del conjunto de los parses de Europa del Este, con relation a los otros paises, aunque sea modesta, no fué jarnas tan évidente. El examen de la evolution de los principales indicadores, relatives a los modos de constitution de la familia (indices sintéticos de nupcialidad de los solteros, y del divorcio, proportion de nacimientos extra conyugales) muestra como los comportamientos familiares tendieron a aproximarse en los paises de Europa del Este, y a diferenciarse en relación al resto de Europa («Europa del Oeste») a partir de mediados de los aftos 1960. Pero, en el seno mismo de los paises de Europa del Oeste, las evoluciones que se efectuaron, desde háce unos veinte afios, provocaron la aparición de otras particularidades. Los paises del sur de Europa, en particular, se caracterizan hoy en dia, por presentar una situation relativamente original. Es también, a partir de mediados de los afíos 1960, que la evolution de la mortalidad révéla una cierta «desviación» en los paises de Europa del Este, donde la lucha contra la mortalidad se estanca, en un momento, que ella registraba progresos sensibles en los otros paises, principalmente a partir de los afios 1970. El examen de las principales causas de mortalidad, muestra como en ése movimiento, los paises de Europa del Este, aunque diferenciandose de Europa del Oeste, vieron resaltar las diferencias que presentaban entre ellos : de cierta manera, hubo unification al Oeste, division al Este. Europa del Este aparece hoy en dia diferente. Sin embargo ni el Este, ni el Oeste de Europa no constituyen entidades homogéneas., Monnier Alain, Rychtarikova Jitka. Comment l'Europe s'est divisée entre l'Est et l'Ouest. In: Population, 46ᵉ année, n°6, 1991. pp. 1617-1650.

Recent Health Transition in the Czech Republic. The Czech Republic has not known the mortality increase observed in other ex-communist countries during the transition period. On the contrary, since 1991, mortality decrease has intensified. A favorable turnover has been noticed for adults and the elderly, the latter due to fast decrease in mortality from circulatory diseases. Male survival improvement has been more important particularly in regards to the previous unfavorable male mortality patterns. The increase in life expectancy at birth between 1989 and 1996 by 2,26 years for males and 1,86 years for females was due to a decline in mortality due to circulatory diseases (an increase of life expectancy at birth by 1,05 years for males and by 0,98 years for females). Only the mortality decline from heart attacks has resulted in the increase of mean length of life by 0,65 years for males and by 0,32 years for females. The mortality analysis by marital status made by a method of multiple indirect standardization (intensity regression model) has shown deeper differences according to marital status for males than for females. The lowest mortality level has been observed for married people. Divorced males and single females displayed the worst survival patterns. In the period 1985-1996, inequalities in mortality by marital status have been widening due to a faster mortality decline of married people. Regional perspectives have revealed that spatial distribution of mortality patterns has not changed; the highest mortality in North-West Bohemia contrasts with the lowest level in South-East Moravia including the Eastern and South-Eastern part of Bohemia., La République tchèque n'a pas connu l'augmentation de la mortalité observée dans d'autres anciens pays communistes pendant la période de transition. Au contraire, depuis 1991, le déclin s'est intensifié. Un changement favorable a été observé pour les adultes et les personnes âgées, le second étant dû à la diminution de la mortalité par maladies de l'appareil circulatoire. L'amélioration du nombre d'hommes survivants a été particulièrement importante en comparaison des mauvaises tendances de leur mortalité. Ainsi, l'augmentation de l'espérance de vie à la naissance entre 1989 et 1996 a été de 2,26 ans pour les hommes et de 1,86 an pour les femmes. A elle seule, la baisse de la mortalité due aux maladies de l'appareil circulatoire est responsable d'une augmentation de l'espérance de vie 1,05 an pour les hommes et 0,98 an pour les femmes ; de même celle due aux crises cardiaques l'est respectivement pour 0,65 et 0,32 an. L'analyse de la mortalité selon le statut matrimonial, à l'aide d'une méthode de standardisation indirecte montre que les différences liées à ce facteur sont plus importantes pour les hommes que pour les femmes. Les indices de mortalité les plus faibles ont été observés pour les personnes mariées alors que les hommes divorcés et les femmes célibataires ont les plus faibles probabilités de survie. Dans la période 1985-1996 les différences de mortalité selon le statut matrimonial ont augmenté fortement à cause du déclin de la mortalité des personnes mariées. Par contre, l'étude des perspectives régionales montre une tendance au maintien des disparités spatiales ; les indices de mortalité les plus élevés sont toujours observés dans le nord-ouest de la Bohème ce qui contraste avec les taux les plus faibles que l'on rencontre dans le sud-est de la Moravie et l'est et le sud-est de la Bohème., Rychtarikova Jitka. La République tchèque va-t-elle sortir de la crise de santé de l'Europe de l'Est?. In: Espace, populations, sociétés, 1998-3. Les mutations démographiques en Europe centrale et orientale - Population Transformations in Central and Eastern Euraope. pp. 371-379.

Populations and Borders: the Case of Czechoslovakia. The authors compare the demographical evolution in borderlands and hinterlands, between the 1869' and 1991' censuses. They observe the effects of the second world war which has disturbed the structures and the behaviours of the population. The effects of the border are the most noticeable near Germany., Les auteurs comparent l'évolution démographique des districts frontaliers et intérieurs en Tchécoslovaquie, entre les recensements de 1869 et de 1991. Ils soulignent l'importance de la Seconde Guerre mondiale qui a modifié les structures et les comportements de la population. C'est surtout au contact avec l'Allemagne que les effets de la frontière furent et demeurent les plus sensibles., Rychtarikova Jitka, Rehak Jan. Populations et frontières : le cas de la Tchécoslovaquie. In: Espace, populations, sociétés, 1992-2. Population et frontières - Population and frontiers. pp. 185-201.

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.