Changes in mortality inequalities over two decades

Register based study of European countries

Datos Bibliográficos

ID23328357
AutoresJ P Mackenbach (0000-0002-8954-6557, Erasmus MC, autor de correspondencia), Ivana Kulhánová (0000-0002-9688-1548, Erasmus MC), Barbara Artnik (0000-0003-4090-5229, Community Health Centre Ljubljana), M Bopp (0000-0003-0766-3723, University of Zurich), Carme Borrell (0000-0002-1170-2505, Agència de Salut Pública de Catalunya), Tom Clemens (0000-0002-6979-0026, University of Edinburgh), Giuseppe Costa (0000-0003-3187-4889, University of Turin), Chris Dibben (0000-0003-1769-3774, University of Edinburgh), Ramune Kalediene (0000-0003-3434-8091, Lithuanian University of Health Sciences), Olle Lundberg (0000-0001-7795-3713, Centre for Health Equity Studies), Pekka Martikainen (0000-0001-9374-1438, University of Helsinki), Gwenn Menvielle (0000-0002-3261-6366, Inserm), Olof Östergren (0000-0002-7156-3260, Centre for Health Equity Studies), Remigijus Prochorskas (Lithuanian University of Health Sciences), Maica Rodriguez‐sanz (0000-0002-3772-1798, Agència de Salut Pública de Catalunya), Maica Rodríguez-Sanz, Bjorn H Strand (0000-0003-4385-8886, Norwegian Institute of Public Health), Bjørn Heine Strand, Caspar W N Looman (Erasmus MC), Rianne de Gelder (Erasmus MC)
Año2016
Volumen353
Páginasi1732
Fecha de publicación2016-04-11
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ (JOURNAL)
Identificadores de la revistaISSN: 0007-1447 • E-ISSN: 0267-0623
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmj.i1732
PMID27067249
OpenAlexW2323914450
IdiomaEN
Citas recibidas77
Referencias citadas20

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.

Census · Geography · Inequality · Mortality rate · Population · Socioeconomic status · Socioeconomics · Sociology · Chronic Disease Management Strategies · Demography · Employment and Welfare Studies · Health disparities and outcomes · Mathematics