Changes in mortality inequalities over two decades: register based study of European countries

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Changes in mortality inequalities over two decades : register based study of European countries

Mackenbach, Johan P. (author): Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands

Kulhanova, Ivana (author): Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands

Artnik, Barbara (author): Fac Med, Dept Publ Hlth, Ljubljana, Slovenia

Bopp, Matthias (author): Univ Zurich, Epidemiol Biostat & Prevent Inst, CH-8006 Zurich, Switzerland

Borrell, Carme (author): Agencia Salut Publ Barcelona, Barcelona, Spain

Clemens, Tom (author): Univ Edinburgh, Sch Geosci, Edinburgh, Midlothian, Scotland

Costa, Giuseppe (author): Univ Turin, Dept Clin Med & Biol, I-10124 Turin, Italy

Dibben, Chris (author): Univ Edinburgh, Sch Geosci, Edinburgh, Midlothian, Scotland

Kalediene, Ramune (author): Lithuanian Univ Hlth Sci, Kaunas, Lithuania

Lundberg, Olle (author): Stockholms universitet,Mittuniversitetet,Avdelningen för hälsovetenskap,Ctr Hlth Equ Studies, Stockholm, Sweden,Centrum för forskning om ojämlikhet i hälsa (CHESS),Mid Sweden University, Sweden

Martikainen, Pekka (author): Univ Helsinki, Dept Sociol, FIN-00014 Helsinki, Finland

Menvielle, Gwenn (author): Univ Paris 04, INSERM, IPLESP, UMRS 1136, F-75230 Paris 05, France

Östergren, Olof (author): Stockholms universitet,Karolinska Institutet,Centrum för forskning om ojämlikhet i hälsa (CHESS)

Prochorskas, Remigijus (author)

Rodriguez-Sanz, Maica (author): Agencia Salut Publ Barcelona, Barcelona, Spain

Strand, Bjorn Heine (author): Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway

Looman, Caspar W. N. (author): Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands

de Gelder, Rianne (author): Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands

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2016-04-11
2016
English.
In: The BMJ. - : BMJ. - 1756-1833. ; 353

Related links:: https://miun.diva-po... (primary) (Raw object); show more...; https://www.bmj.com/...; https://doi.org/10.1...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; https://urn.kb.se/re...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

Articles in the publication: The BMJ; BMJ Open

By the university: Mid Sweden University; Karolinska Institutet; Stockholm University

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