Mind the Gap: A study in cause-specific mortality by socio-economic circumstances

Socioeconomic groups may be exposed to varying levels of mortality; this is certainly the case in the United Kingdom, where the gaps in life expectancy, differentiated by socioeconomic circumstances, are widening. The reasons for such diverging trends are yet unclear, but a study of cause-specific mortality may provide rich insight into this phenomenon. Therefore, we investigate the relationship between socioeconomic circumstances and cause-specific mortality using a unique dataset obtained from the U.K. Office for National Statistics. We apply a multinomial logistic framework; the reason is twofold. First, covariates such as socioeconomic circumstances are readily incorporated, and, second, the framework is able to handle the intrinsic dependence amongst the competing causes. As a consequence of the dataset and modeling framework, we are able to investigate the impact of improvements in cause-specific mortality by socioeconomic circumstances. We assess the impact using (residual) life expectancy, a measure of aggregate mortality. Of main interest are the gaps in life expectancy among socioeconomic groups, the trends in these gaps over time, and the ability to identify the causes most influential in reducing these gaps. This analysis is performed through the investigation of different scenarios: first, by eliminating one cause of death at a time; second, by meeting a target set by the World Health Organization (WHO), called WHO 25 × 25; and third, by developing an optimal strategy to increase life expectancy and reduce inequalities