Changes in mortality inequalities over two decades: register based study of European countries.
- Mackenbach JP Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands j.mackenbach@erasmusmc.nl.
- Kulhánová I Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
- Artnik B Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia.
- Bopp M Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland.
- Borrell C Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Clemens T School of Geosciences, University of Edinburgh, Edinburgh.
- Costa G Department of Clinical Medicine and Biology, University of Turin, Italy.
- Dibben C School of Geosciences, University of Edinburgh, Edinburgh.
- Kalediene R Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Lundberg O Center for Health Equity Studies, Stockholm, Sweden Department of Health Sciences, Mid Sweden University, Östersund.
- Martikainen P Department of Sociology, University of Helsinki, Finland.
- Menvielle G Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
- Östergren O Center for Health Equity Studies, Stockholm, Sweden.
- Prochorskas R Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Rodríguez-Sanz M Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Strand BH Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
- Looman CW Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
- de Gelder R Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
- 2016-04-13
Published in:
- BMJ (Clinical research ed.). - 2016
Adult
Aged
Cause of Death
Censuses
Educational Status
Europe
Female
Healthcare Disparities
Humans
Longitudinal Studies
Male
Middle Aged
Registries
Sex Factors
Socioeconomic Factors
English
OBJECTIVE
To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.
DESIGN
Register based study.
DATA SOURCE
Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively).
SETTING
All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania.
RESULTS
Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations.
CONCLUSIONS
Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.
To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.
DESIGN
Register based study.
DATA SOURCE
Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively).
SETTING
All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania.
RESULTS
Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations.
CONCLUSIONS
Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1136/bmj.i1732
- PMID 27067249
- Persistent URL
- https://sonar.ch/global/documents/263439
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