| 1. |
- Chen-Xu, José, et al.
(författare)
-
Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19 : an ecological study
- 2024
-
Ingår i: The Lancet Public Health. - : Elsevier. - 2468-2667. ; 9:3, s. e166-e177
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic.METHODS: In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models.FINDINGS: Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]).INTERPRETATION: Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA.
|
|
| 2. |
- Agardh, Emilie E., et al.
(författare)
-
Disease Burden Attributed to Drug use in the Nordic Countries : a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2019
- 2023
-
Ingår i: International Journal of Mental Health and Addiction. - 1557-1874 .- 1557-1882.
-
Tidskriftsartikel (refereegranskat)abstract
- The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001-2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566-600 DALYs among males from 1990 to 2010 and 210-240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.
|
|
| 3. |
- Agardh, Emilie E., et al.
(författare)
-
Alcohol-attributed disease burden in four Nordic countries between 2000 and 2017 : Are the gender gaps narrowing? A comparison using the Global Burden of Disease, Injury and Risk Factor 2017 study
- 2021
-
Ingår i: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 40:3, s. 431-442
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction and Aims. The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (DALY), in four Nordic countries in 2000-2017, to find out if gender gaps in DALYs had narrowed. Design and Methods. Alcohol-attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. Results. In 2017, all-cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000-2017, absolute gender differences in all-cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. Discussion and Conclusions. The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.
|
|
| 4. |
- Borisova, Liubov, 1984-, et al.
(författare)
-
Public evaluation of health services across 21 European countries : The role of culture
- 2017
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:2, s. 132-139
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: This work examined the role of cultural values in understanding people’s satisfaction with health services across Europe. Methods: We used multilevel linear regression analysis on the seventh round of the European Social Survey from 2014, including c. 40,000 respondents from 21 countries. Preliminary intraclass correlation analyses led us to believe that some explanations of variance in the dependent variable were to be found at the country level. In search of country level explanations, we attempted to account for the role of national culture in influencing citizens’ attitudes towards health systems. This was done by using Hofstede’s dimensions of power distance, individualism, masculinity and uncertainty avoidance, giving each country in the survey a mean aggregated score. Results: In our first model with individual level variables, being female, having low or medium education, experiencing financial strain, and reporting poor health and unmet medical needs were negatively associated with individual satisfaction with national healthcare systems, with the latter variable showing the strongest effect. After including Hofstede’s cultural dimensions in our multilevel model, we found that the power distance index variable had a negative effect on the dependent variable, significant at the 0.1 level. Conclusions: Citizens are likely to evaluate their national health system more negatively in national cultures associated with autocracy and hierarchy.
|
|
| 5. |
- Eikemo, Terje A., et al.
(författare)
-
How Can Inequalities in Mortality Be Reduced? : A Quantitative Analysis of 6 Risk Factors in 21 European Populations
- 2014
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:11, s. e110952-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.
|
|
| 6. |
- Fjaer, Erlend L., et al.
(författare)
-
Subjective perceptions of unmet need for health care in Europe among social groups : Findings from the European social survey (2014) special module on the social determinants of health
- 2017
-
Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 27:S1, s. 82-89
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Unmet need can be defined as the individually perceived subjective differences between services judged necessary to deal with health problems and the services actually received. This study examines what factors are associated with unmet need, as well as how reasons for unmet need are distributed across socioeconomic and demographic groups in Europe.Methods: Multilevel logistic regression models were employed using data from the 7th round of the European Social Survey, on people aged 25–75. Self-reported unmet need measured whether respondents had been unable to get medical consultation or treatment in the last 12 months. Reasons for unmet need were grouped into three categories: availability, accessibility and acceptability. Health status was measured by self-reported health, non-communicable diseases and depressive symptoms.Results: Two-thirds of all unmet need were due waiting lists and appointment availability. Females and young age groups reported more unmet need. We found no educational inequalities, while financial strain was found to be an important factor for all types of unmet need for health care in Europe. All types of health care use and poor health were associated with unmet need. Low physician density and high out-of-pocket payments were found to be associated with unmet need due to availability.Conclusion: Even though health care coverage is universal in many European welfare states, financial strain appeared as a major determinant for European citizens’ access to health care. This may suggest that higher income groups are able to bypass waiting lists. European welfare states should, therefore, intensify their efforts in reducing barriers for receiving care.
|
|
| 7. |
- Kulhánová, Ivana, et al.
(författare)
-
Assessing the potential impact of increased participation in higher education on mortality : Evidence from 21 European populations
- 2014
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 117, s. 142-149
-
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.
|
|
| 8. |
- Kulhánová, Ivana, et al.
(författare)
-
Socioeconomic differences in the use of ill-defined causes of death in 16 European countries
- 2014
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
-
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.
|
|
| 9. |
- Kulhánová, Ivana, et al.
(författare)
-
The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe
- 2017
-
Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 27:2, s. 203-210
-
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.
|
|
| 10. |
- Li, Baojing, et al.
(författare)
-
Educational level and the risk of mental disorders, substance use disorders and self-harm in different age-groups : A cohort study covering 1,6 million subjects in the Stockholm region
- 2023
-
Ingår i: International Journal of Methods in Psychiatric Research. - : Wiley. - 1049-8931 .- 1557-0657. ; 32:4
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the associations between low education and risk of mental disorders, substance use disorders and self-harm in different age-groups.Methods: All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed-up for these disorders in health care registers 2001–2016. Subjects were stratified into four age-groups: 10–18, 19–27, 28–50, and 51–70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models.Results: Low education increased the risk of substance use disorders and self-harm in all age-groups. Males aged 10–18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19–27 years had increased risks of anxiety and depression, and those aged 28–50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0–1.3) for bipolar disorder to 5.4 (95% CIs 5.1–5.7) for drug use disorder. Females aged 51–70 years had increased risks of schizophrenia and autism.Conclusion: Low education is associated with risk of most mental disorders, substance use disorders and self-harm in all age-groups, but especially among those aged 28–50 years.
|
|
| 11. |
- Mackenbach, Johan P, et al.
(författare)
-
Trends in inequalities in premature mortality : a study of 3.2 million deaths in 13 European countries.
- 2015
-
Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 69, s. 207-217
-
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.
|
|
| 12. |
- Rydland, Håvard T, et al.
(författare)
-
Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems
- 2020
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:7
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types.METHODS: This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities.RESULTS: All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences.CONCLUSIONS: This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
|
|
| 13. |
- Toch-Marquardt, Marlen, et al.
(författare)
-
Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s
- 2014
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:9, s. e108072-
-
Tidskriftsartikel (refereegranskat)abstract
- This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e. g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.
|
|
