Few studies have investigated socioeconomic status (SES) and external causes of death (ie, deaths attributable to injuries). These deaths are of particular interest because they are potentially preventable and they represent the second leading cause of years of life lost under age 75. We studied 261,723 deaths from external causes in 27 states from 1984 to 1997 among employed persons age 20-64. Numerator data came from occupation on the death certificate. Occupation-specific denominator data came from the U.S. Census. A Nam-Powers SES score was assigned to each occupation based on its relative income and education in the U.S. Census. After adjusting for age, sex, year and race, SES was strongly associated with mortality from all external causes combined for men (rate ratios = 2.9, 2.3, 1.5, and 1.0 by ascending SES quartile), and to a lesser extent for women (rate ratios = 1.6, 1.0, 1.1, and 1.0). A similar pattern was seen for each of the specific external causes (motor vehicle deaths, suicide, homicide, injuries other than by motor vehicle, and medical complications). We estimate 41% of deaths from external causes are attributable to having a SES below the top quartile (both sexes combined).
Kyle Steenland, Emory School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322