Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
Por:
Mackenbach, JP, Valverde, JR, Bopp, M, Bronnum-Hansen, H, Costa, G, Deboosere, P, Kalediene, R, Kovacs, K, Leinsalu, M, Martikainen, P, Menvielle, G, Rodriguez-Sanz, M, Nusselder, WJ
Publicada:
1 dic 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.
Filiaciones:
Mackenbach, JP:
Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands
Valverde, JR:
Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands
Bopp, M:
Univ Zurich, Epidemiol Biostat & Prevent Inst, Zurich, Switzerland
Bronnum-Hansen, H:
Univ Copenhagen, Inst Publ Hlth, Copenhagen, Denmark
Costa, G:
Univ Turin, Dept Clin Med & Biol, Turin, Italy
Deboosere, P:
Vrije Univ Brussel, Dept Sociol, Brussels, Belgium
Kalediene, R:
Lithuanian Univ Hlth Sci, Kaunas, Lithuania
Kovacs, K:
Demog Res Inst, Budapest, Hungary
Leinsalu, M:
Sodertorn Univ, Stockholm Ctr Hlth & Social Change, Stockholm, Sweden
Natl Inst Hlth Dev, Dept Epidemiol & Biostat, Tallinn, Estonia
Martikainen, P:
Univ Helsinki, Dept Sociol, Helsinki, Finland
Menvielle, G:
Sorbonne Univ, IPLESP, INSERM, UMRS 1136, Paris, France
Rodriguez-Sanz, M:
Agencia Salut Publ Barcelona, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Nusselder, WJ:
Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands
Green Published, hybrid
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