Inequality among men in standardised years of potential life lost, 1970-93.

We used population data from the 10% sample of each relevant census. This sample is coded to the registrar general’s social classification. Only men aged 20-64 years were included because many men outside this age range could not be allocated to a social class. Deaths by age and social class for 1970-2, 1979-80 and 1982-3, and 1991-3 (used in decennial supplements to the census 1, 6, 15) come from the database at the Office for National Statistics. The categories of cause of death examined are all causes, ischaemic heart disease, malignant neoplasms, and accidents and violence (ICD-9 codes 001-999, 410414, 140-208, and E800-E999). We used the population of England and Wales in 1981 as the standard to achieve comparability across the three decades. We modified Romeder and McWhinnie’s method to calculate age adjusted rates of years of potential life lost per 1000 population: ^ (65-ag)× dg× Mg×1000 pg M where ag = mid-age of age group; dg = number of deaths in age and social class group; pg = population in age and social class group; Mg = number of males in England and Wales in 1981 in age group; and M = number of males aged 20-64 in England and Wales in 1981. The table shows social class differences in standardised years of potential life lost. The ratio of deaths due to all causes between social classes I and V widened from 2.1 in 1970-2 to 2.9 in 1979-80 and 1982-3, and to 3.3 in 1991-3. All the main causes of death contributed to this widening, especially ischaemic heart disease, for which the ratio between social classes I and V more than doubled, from 1.5 in 1970-2 to 3.4 in 1991-3. Social class IV became more similar to class III manual in all cause mortality (leaving class V as a disadvantaged outlier) primarily because of the change in accidents and violence (the number of years lost increased in class III manual and decreased in class IV) and malignant neoplasms (the number of years lost is now lower in class IV than class III manual). By 1991-3 accidents and violence were as important as ischaemic heart disease and malignant neoplasms for each social class, and more important for class V.