Trends in health inequalities in 27 European countries
Por:
Mackenbach, JP, Valverde, JR, Artnik, B, Bopp, M, Bronnum-Hansen, H, Deboosere, P, Kalediene, R, Kovacs, K, Leinsalu, M, Martikainen, P, Menvielle, G, Regidor, E, Rychtarikova, J, Rodriguez-Sanz, M, Vineis, P, Whiten, C, Wojtyniak, B, Hu, YN, Nusselder, WJ
Publicada:
19 jun 2018
Resumen:
Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca. 1980 to ca. 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca. 2002 to ca. 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.
Filiaciones:
Mackenbach, JP:
Erasmus Univ, Med Ctr, Dept Publ Hlth, NL-3015 CE Rotterdam, Netherlands
Valverde, JR:
Erasmus Univ, Med Ctr, Dept Publ Hlth, NL-3015 CE Rotterdam, Netherlands
Artnik, B:
Fac Med, Dept Publ Hlth, Ljubljana 1000, Slovenia
Bopp, M:
Univ Zurich, Epidemiol Biostat & Prevent Inst, CH-8006 Zurich, Switzerland
Bronnum-Hansen, H:
Univ Copenhagen, Inst Publ Hlth, DK-1165 Copenhagen, Denmark
Deboosere, P:
Vrije Univ Brussel, Dept Sociol, B-1050 Ixelles, Belgium
Kalediene, R:
Lithuanian Univ Hlth Sci, LT-44307 Kaunas, Lithuania
Kovacs, K:
Demog Res Inst, H-1525 Budapest, Hungary
Leinsalu, M:
Sodertorn Univ, Stockholm Ctr Hlth & Social Change, Huddinge, Sweden
Natl Inst Hlth Dev, Dept Epidemiol & Biostat, EE-11619 Tallinn, Estonia
Martikainen, P:
Univ Helsinki, Dept Sociol, Helsinki 00100, Finland
Menvielle, G:
Sorbonne Univ, IPLESP, INSERM, UMRS 1136, F-75646 Paris, France
Regidor, E:
Univ Complutense Madrid, Dept Prevent Med & Publ Hlth, E-28040 Madrid, Spain
Rychtarikova, J:
Charles Univ Prague, Dept Demog, Prague 12843 2, Czech Republic
Rodriguez-Sanz, M:
Agencia Salut Publ Barcelona, Barcelona 08023, Spain
Vineis, P:
Imperial Coll, Sch Publ Hlth, Publ Hlth England Ctr Environm & Hlth, MRC, London W2 1PG, England
Whiten, C:
Off Natl Stat, Newport NP10 8XG, Shrops, England
Wojtyniak, B:
Natl Inst Publ Hlth, Nat Inst Hyg, Dept Monitoring & Anal Populat Hlth, PL-00791 Warsaw, Poland
Hu, YN:
Erasmus Univ, Med Ctr, Dept Publ Hlth, NL-3015 CE Rotterdam, Netherlands
Nusselder, WJ:
Erasmus Univ, Med Ctr, Dept Publ Hlth, NL-3015 CE Rotterdam, Netherlands
Green Published, Green Submitted
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