- Changes in mortality inequalities over two decades: register based study of European countries
- 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 ...
Johan P Mackenbach, Ivana Kulhanova, Barbara Artnik, Mattias Bopp, Carme Borrell, Tom Clemens, Giuseppe Costa, Chris Dibben, Ramune Kaladiene, Olle Lundberg, Pekka Martikainen, Gwenn Menvielle, Olof Ostergren, Remigijus Prochorskas, Maica Rodríguez-Sanz, Bjorn Heine Strand, Caspar W N Looman, Rianne de Gelder
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