Class-related health inequalities are not larger in the East

Background: The article investigates whether people in Eastern Europe have larger health inequalities than their counterparts in three West European regions (North, Central and the South). Methods: Data were obtained for 63 754 individuals in 23 countries from the first (2002) and second (2004) waves of the European Social Survey. The health outcomes were self-reported limiting longstanding illness and fair/poor general health. Occupational class was defined according to the European Socioeconomic Classification (ESeC). The magnitude of absolute and relative inequalities according to nine occupational classes for men and women separately were identified, analysed and compared in all four regions of Europe. Results: For both sexes and within all European regions, the higher and lower professionals, self-employed and higher service wo

Why does Spain have smaller inequalities in mortality?

Background: While educational inequalities in mortality are substantial in most European countries, they are relatively small in Spain. A better understanding of the causes of these smaller inequalities in Spain may help to develop policies to reduce inequalities in mortality elsewhere. The aim of the present study was therefore to identify the specific causes of death and determinants contributing to these smaller inequalities. Methods: Data on mortality by education were obtained from longitudinal mortality studies in three Spanish populations (Barcelona, Madrid, the Basque Country), and six other Western European populations. Data on determinants by education were obtained from health interview surveys. Results: The Spanish populations have considerably smaller absolute inequalities in mortality than other Western European populations. This is due mainly to smaller inequalities in mortality from cardiovascular disease (men) and cancer (women). Inequalities in mortality from most other causes are not smaller in Spain than elsewhere. Spain also has smaller inequalities in smoking and sedentary lifestyle and this is due to more smoking and physical inactivity in higher educated groups. Conclusion: Overall, the situation with regard to health inequalities does not appear to be more favourable in Spain than in other Western European populations. Smaller inequalities in mortality from cardiovascular disease and cancer in Spain are likely to be related to its later socio-economic modernization. Although these smaller inequalities in mortality seem to be a historical coincidence rather than the outcome of deliberate policies, the Spanish example does suggest that large inequalities in total mortality are

Educational inequalities in mortality by cause of death

Objectives Using new facilities for linking large dat- abases, we aimed to evaluate for the first time the magnitude of relative and absolute educational inequalities in mortality by sex and cause of death in the Netherlands. Methods We analyzed data from Dutch Labour Force Surveys (1998–2002) with mortality follow-up 1998–2007 among people aged 30–79 years. We calculated hazard ratios using Cox proportional hazards model, age-stan- dardized mortality rates and partial life expectancy by education. We compared results for the Netherlands with those for other European countries. Results The relative risk of dying was about two times higher among primary educated men and women as com- pared to their tertiary educated counterparts, leading to a gap in pa

The potential impact of a social redistribution of specific risk factors on socioeconomic inequalities in mortality: Illustration of a method based on population attributable fractions

Background: Socioeconomic differences in health are a major challenge for public health. However, realistic estimates to what extent they are modifiable are scarce. This problem can be met through the systematic application of the population attributable fraction (PAF) to socioeconomic health inequalities. Methods: The authors used cause-specific mortality data by educational level from Belgium, Norway and Czech Republic and data on the prevalence of smoking, alcohol, lack of physical activity and high body mass index from national health surveys. Information on the impact of these risk factors on mortality comes from the epidemiological literature. The authors calculated PAFs to quantify the impact on socioeconomic health inequalities of a social redistribution of risk factors. The authors developed an Excel tool covering a wide range of possible scenarios and the authors compare the results of the PAF approach with a conventional regression. Results: In a scenario where the whole population gets the risk factor prev

Assessing the potential impact of increased participation in higher education on mortality

Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populatio