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Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015.

  • Mackenbach JP Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl.
  • Rubio Valverde J Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
  • Bopp M Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
  • Brønnum-Hansen H Institute of Public Health, Copenhagen University, Copenhagen, Denmark.
  • Costa G Department of Clinical Medicine and Biology, University of Turin, Turin, Italy.
  • Deboosere P Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
  • Kalediene R Lithuanian University of Health Sciences, Kaunas, Lithuania.
  • Kovács K Demographic Research Institute, Budapest, Hungary.
  • Leinsalu M Stockholm Centre for Health and Social Change, Södertörn University, Stockholm, Sweden.
  • Martikainen P Department of Sociology, University of Helsinki, Helsinki, Finland.
  • Menvielle G INSERM, Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
  • Rodriguez-Sanz M Agència de Salut Pública de Barcelona, Barcelona, Spain.
  • Nusselder WJ Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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  • 2019-11-16
Published in:
  • European journal of epidemiology. - 2019
Europe
Mortality
Social inequality
Trends
Cause of Death
Educational Status
Europe
Female
Health Expenditures
Health Status Disparities
Healthcare Disparities
Humans
Male
Mortality
Registries
Sex Distribution
Sex Factors
Social Class
Socioeconomic Factors
English Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.
Language
  • English
Open access status
hybrid
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Persistent URL
https://sonar.ch/global/documents/4216
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