Authors' response to Gupta and Pednekar: Importance of examining cause-specific proportions of deaths as well as mortality rates

Abstract

It is not clear what Gupta and Pednekar mean when they state, ‘We decided to look at our Mumbai Cohort Study data once again to look at the burden of the CVD mortality by educational status’.1 We not only had cited but also used their data from their previously published study2 to illustrate the importance of examining both mortality rates between different educational categories (which they do), as well as the proportion of deaths attributable to different causes in different educational categories3(see Figure 2 of our original paper3). In their letter,1 Gupta and Pednekar present a re-analysis of age-adjusted mortality rates that they have published before,2 although in the letter they coarsened the five educational categories (which they had used in their original publication2) to two categories of ‘lower education groups’ and ‘higher education groups’ and combined across men and women. It seems erroneous, for instance, to group illiterate individuals with those with primary- and middle-school education, especially when their own data demonstrated age-adjusted cardiovascular disease (CVD) and ischaemic heart disease (IHD) mortality rates for men were higher for those with primary- or middle-school education and lower for those who were illiterate or have a secondary-school or college education2 (also see the line graph in Figure 2 of our original paper3