National estimates of occupation-related inequalities in all-cause mortality using linked Census-mortality data

Objective: This report aims to provide national estimates of occupation-related inequalities in all-cause mortality for Australian residents aged 25–64 years. Method: Data came from the 2016 Census linked to Deaths Registrations, available via the Multi-Agency Data Integration Project. Using negative binomial regression, we estimated age-adjusted relative and absolute inequalities in all-cause mortality rates in the 13 months following Census according to occupation, defined using the Australian and New Zealand Standard Classification of Occupations (eight major groups), using managers as the reference group. Results: Among 10.8M people, there were 20,987 deaths. Age-adjusted mortality rates were lowest among managers and professionals and were generally highest for manual occupations, for example, among men, relative risks (RR) for labourers ranged across age groups from 1.44 (95% CI 1.19–1.75, age 54–64) to 2.99 (1.93–4.65, age 25–34); among women, the RR for machine operators and drivers were 3.95 (1.39–11.21 in age 25–24 and 2.73 (1.66–4.49) in age 45–54, but there was relatively little variation by occupation in women aged 35–44 and 55–64. Around one in five deaths (23% for men, 17% for women) were associated with being in an occupation other than manager. Conclusion: These findings highlight that there is benefit in documenting national mortality inequalities according to occupation in addition to other measures of socioeconomic position. They provide further insights into socioeconomic inequalities in mortality. Implications for public health: Methods that aim to reduce mortality for those in manual occupations, particularly among young men, will reduce inequalities and improve population health.