Progress against inequalities in mortality : register-based study of 15 European countries between 1990 and 2015
Mackenbach, J.P (Erasmus MC)
Rubio Valverde, José (Erasmus MC)
Bopp, Matthias (University of Zürich)
Brønnum-Hansen, Henrik (Copenhagen University)
Costa, Giuseppe (University of Turin)
Deboosere, Patrick (Vrije Universiteit Brussel)
Kalediene, Ramune (Lithuanian University of Health Sciences)
Kovács, Katalin (Demographic Research Institute)
Leinsalu, Mall (National Institute for Health Development)
Martikainen, Pekka (University of Helsinki)
Menvielle, Gwenn (Sorbonne Universités)
Rodríguez-Sanz, Maica (Institut d'Investigació Biomèdica Sant Pau)
Nusselder, Wilma J. (Erasmus MC)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e. g. , 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Europe ; Mortality ; Social inequality ; Trends
Publicado en:	European Journal of Epidemiology, Vol. 34 Núm. 12 (january 2019) , p. 1131-1142, ISSN 1573-7284

DOI: 10.1007/s10654-019-00580-9
PMID: 31729683

12 p, 2.2 MB

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