| 1. |
- Gadeyne, S, et al.
(författare)
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The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s
- 2017
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Ingår i: International Journal of Cancer. - : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 141:1, s. 33-44
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.
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| 2. |
- Mackenbach, J. P., et al.
(författare)
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Variations in the relation between education and cause-specific mortality in 19 European populations : A test of the "fundamental causes" theory of social inequalities in health
- 2015
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 127, s. 51-62
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Tidskriftsartikel (refereegranskat)abstract
- Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities.We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30-79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable.Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education-mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large.In conclusion, our results provide some further support for the theory of "fundamental causes". However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.
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| 3. |
- Vandenheede, H., et al.
(författare)
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Educational inequalities in diabetes mortality across Europe in the 2000s : the interaction with gender
- 2015
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Ingår i: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 60:4, s. 401-410
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders. Methods: Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and ‘gender × educational rank’. Results: An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0–3.9) in men versus 4.8 (95 % CI 3.2–7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated. Conclusions: Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies. © 2015 The Author(s)
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| 4. |
- Kulik, M. C., et al.
(författare)
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Smoking and the potential for reduction of inequalities in mortality in Europe
- 2013
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 28:12, s. 959-971
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Tidskriftsartikel (refereegranskat)abstract
- Socioeconomic inequalities in health and mortality remain a widely recognized problem. Countries with smaller inequalities in smoking have smaller inequalities in mortality, and smoking plays an important part in the explanation of inequalities in some countries. We identify the potential for reducing inequalities in all-cause and smoking-related mortality in 19 European populations, by applying different scenarios of smoking exposure. Smoking prevalence information and mortality data come from 19 European populations. Prevalence rates are mostly taken from National Health Surveys conducted around the year 2000. Mortality rates are based on country-specific longitudinal or cross-sectional datasets. Relative risks come from the Cancer Prevention Study II. Besides all-cause mortality we analyze several smoking-related cancers and chronic obstructive pulmonary disease/asthma. We use a newly-developed tool to quantify the changes in population health potentially resulting from modifying the population distribution of exposure to smoking. This tool is based on the epidemiological measure of the population attributable fraction, and estimates the impact of scenario-based distributions of smoking on educational inequalities in mortality. The potential reduction of relative inequality in all-cause mortality between those with high and low education amounts up to 26 % for men and 32 % for women. More than half of the relative inequality may be reduced for some causes of death, often in countries of Northern Europe and in Britain. Patterns of potential reduction in inequality differ by country or region and sex, suggesting that the priority given to smoking as an entry-point for tackling health inequalities should differ between countries.
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| 5. |
- Kulhánová, Ivana, et al.
(författare)
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Assessing the potential impact of increased participation in higher education on mortality : Evidence from 21 European populations
- 2014
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 117, s. 142-149
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Tidskriftsartikel (refereegranskat)abstract
- Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.
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| 6. |
- Kulhánová, Ivana, et al.
(författare)
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Socioeconomic differences in the use of ill-defined causes of death in 16 European countries
- 2014
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics.METHODS: Using age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to "Symptoms, signs and ill-defined conditions". We tested if this proportion differed across educational groups using Chi-square tests.RESULTS: The proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people.CONCLUSIONS: We found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.
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| 7. |
- Kulhánová, Ivana, et al.
(författare)
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The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe
- 2017
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 27:2, s. 203-210
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios-the upward levelling scenario and the more realistic best practice country scenario.METHODS: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30-79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s.RESULTS: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated.CONCLUSION: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.
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| 8. |
- Mackenbach, Johan P, et al.
(författare)
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Trends in inequalities in premature mortality : a study of 3.2 million deaths in 13 European countries.
- 2015
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 69, s. 207-217
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century.METHODS: We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia.RESULTS: Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries.CONCLUSIONS: Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.
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| 9. |
- Plug, Iris, et al.
(författare)
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Socioeconomic inequalities in mortality from conditions amenable to medical interventions : do they reflect inequalities in access or quality of health care?
- 2012
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking.MethodsCause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients.ResultsIn most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking.ConclusionsWe did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.
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