Sex differences in child and adolescent mortality by parental education in the Nordic countries.

BACKGROUND: Socioeconomic position inequalities in infant mortality are well known, but there is less information on how child mortality is socially patterned by sex and age.

OBJECTIVE: To assess maternal and paternal socioeconomic inequalities in mortality by sex, whether these differences vary by age and country, and how much of the sex differences can be explained by external causes of death.

METHODS: Data on all live-born children were received from national birth registries for 1981-2000 (Denmark: n=1,184,926; Norway: n=1,090,127; and Sweden n=1,961,911) and for 1987-2000 (Finland: n=841,470). Data on the highest level of education in 2000 were obtained from national education registers, and data on mortality and causes of death were received from the national cause-of-death registers until the end of follow-up (20 years or 2003).

RESULTS: Boys had a higher child and adolescent mortality than girls. The children of mothers and fathers who had had the shortest education time had the highest mortality for both sexes and for all ages and countries. The differences between the groups with longer than basic education were smaller, particularly among older children and girls. The gradient in mortality was mostly similar for boys and girls. Among 1-19-year-olds, 32% of boys' deaths and 27% of girls' deaths were due to external causes.

CONCLUSION: Boys' excess mortality was only partly explained by educational inequalities or by deaths from external causes. A more detailed analysis is needed to study whether the share of avoidable deaths is higher among children whose parents have had a shorter education time.