Occupational class and dementia mortality: evidence from Belgian census-linked data

Socioeconomic inequalities in dementia mortality are well documented, but population-based evidence on occupational class differences remains scarce. This study describes dementia mortality patterns across occupational classes to identify the most vulnerable groups. This study draws on exhaustive data from the 1991 Belgian census, linked to national mortality and emigration registers. Dementia-related deaths were tracked over an 18-year follow-up period (2001–2019). Occupational class was classified according to the Erikson-Goldthorpe-Portocarero (EGP) scheme. Directly age-standardized mortality rates were calculated, and Cox proportional hazards models adjusted for age, education and region were applied to estimate associations with dementia mortality, stratified by sex. Dementia mortality varied systematically across occupational classes, with significantly higher age-standardized mortality rates and hazard ratios among lower occupational classes and inactive individuals, particularly lower skilled workers, compared to higher-level controllers. Notably, self-employed individuals without employees faced elevated dementia mortality risks. The findings confirm persistent occupational inequalities in dementia mortality, with lower-status groups facing elevated risks independent of educational attainment, highlighting the multifaceted role of occupational exposures in cognitive ageing. These results underscore the importance of targeted public health interventions addressing workplace conditions and the heterogeneity within occupational groups, particularly among the self-employed, to reduce dementia-related disparities.