Reversing the Malthusian paradigm on retirement age

Résumé La démographie a toujours influencé la pensée politique. La décision récente d’aug­menter l’âge à la pension dans beaucoup de pays développés est inspirée par l’évo­lution importante de la composition par âge de la population. Mais il y a en réalité peu d’arguments pour augmenter l’âge à la retraite si l’on tient compte de l’ensem­ble des données démographiques et économiques. Une interprétation souvent trop simpliste et même parfois erronée d’indicateurs démographiques contribue à cette démarche. L’utilisation systématique d’indicateurs démographiques dans la discussion sur la viabilité du système des pensions et de la sécurité sociale est selon nous souvent inspirée par la théorie de l’économie de l’offre. Un aspect crucial est le fait que la croissance de la productivité est ignorée ou minimisée. À cet égard, la discussion actuelle présente une profonde similitude avec l’approche Malthusienne de la population. Abstract Demography always influenced political thinking. The recent decision to increase the age of retirement in many high-income countries is driven by a dramatic chan­ge in the age composition of the population. We argue that there is in fact no need to increase the age of retirement and that many aspects of the current evolution both in demography and in economy are overlooked. Moreover, some demographic indicators such as life expectancy or the dependency ratio are often interpreted in a simplistic and erroneous way. The systematic use of demographic indicators to discuss the sustainability of the pension system and of the social security system is in our view often inspired by the supply-side way of economic thinking. A crucial aspect is that productivity increase is ignored or minimalized in the discussion. In this regard the discussion has many similarities with the Malthusian approach of the population question

Data inventory of health inequalities among adolescents and young adults in the Brussels-Capital Region

Résumé Cet article analyse différentes sources de données quant à leur potentiel à étudier et suivre les inégalités de santé parmi les adolescents et les jeunes adultes dans la Région de Bruxelles-Capitale (RBC). Les données du recensement et d’enquêtes sont évaluées quant à leur disponibilité, leur aptitude à se prêter à une analyse sta­tistique, la quantité d’information portant sur des indicateurs-clés, comme la position socio-économique (PSE), l’état de santé, des comportements de santé ou des risques, et les soins de santé. Les certificats de décès couplés avec les données du recensement et l’Enquête de Santé par Interview (HIS) ont été identifiés comme les meilleures sources de données et sont discutées en détail. Les certificats de décès sont couplés aux recensements de 1991 et 2001, ce qui en fait un important outil de monitoring. Le lien entre ces deux bases de données nous permet de suivre la mortalité par cause dans la population jeune de RBC. De plus, le recensement de 2001 fournit de l’information sur le niveau de santé auto-évalué pour l’ensemble de la population. L’information sur les variables de PSE, la structure familiale, l’his­torique des migrations et la nationalité d’origine sont disponibles et permettent la comparaison de la santé perçue et de la mortalité entre différents sous-groupes, en tenant compte de l’impact spécifique de plusieurs déterminants sociaux. Cependant, le monitoring des inégalités de santé parmi les adolescents et les jeunes adul­tes ciblé uniquement sur la mortalité et la santé perçue ne suffit pas à en décrire toutes les facettes. D’autres données sont disponibles pour compléter l’information des bases de données couplées, par exemple celles de la HIS ; nous avons analysé la représentativité et les non-réponses dans les données de la HIS (1997, 2001, 2004, 2008) afin d’identifier son potentiel et ses limites pour l’étude des 15-34 ans. Les avantages de cette enquête sont : la taille suffisante de l’échantillon pour le RBC, la représentativité des 15-34 ans pour la plupart des caractéristiques démographi­ques, une information détaillée sur les comportements de santé, la santé mentale et la consommation de soins, ainsi que sur des déterminants sociaux. Il existe aussi certaines limites : comme dans toute enquête se pose le problème des non-répon­dants, et spécifiquement pour cette enquête, le taux de non-réponses au volet auto-rempli du questionnaire est important et sélectif. De plus, certains modules n’ont pas été utilisés à chaque vague de l’enquête, ce qui limite l’utilisation de don­nées groupées pour certains modules. Summary In this paper, various data sources are analysed in terms of their potential for the study and monitoring of health inequalities among adolescents and young adults in the Brussels-Capital Region (BCR). Routine, census and survey data sources are eva­luated as to their accessibility, their suitability for use in statistical analysis, and the amount of information they can yield on key indicators such as socioeconomic po­sition (SEP), health outcomes, intermediate factors (i.e. health and risk behaviours), and health care. Death certificates linked to census data and the Belgian Health In­terview Survey (BHIS) are identified as the most suitable data sources and are discussed in detail. The linkage of death certificates to the 1991 and 2001 censuses re­sulted in an important tool for health monitoring because the continuity between these two datasets allows for the tracking of cause-specific mortality rates among the BCR’s young population. Additionally, the 2001 census data include information on self-rated health for the entire population. Data on SEP variables, living arran­gement indicators and other sociodemographic variables such as migration history and nationality of origin are available, allowing for comparisons between subgroups of self-rated health and mortality and taking into account the specific impact of a number of social determinants. However, it is insufficient to rely solely on cause-specific mortality and self-rated health for the monitoring of health inequalities among young people as this is too narrow an approach to produce a complete picture of the situation. Other data complementing the information obtained through the linking of datasets are available, such as that collected by the HIS. Re­presentativeness and nonresponse within HIS data (1997, 2001, 2004, 2008) are analysed in order to identify the opportunities and limitations of the HIS for the study of young people. The benefits of this survey are its sample size, sufficiently large for the BCR, the representativeness of 15-to-34-year-olds with regard to most demographic characteristics, and the in-depth information it provides on health be­haviour, mental health and medical consumption, as well as on social determinants of health. This dataset also has its limitations: as with any survey, there is the problem of nonresponse, and in this specific case, the dropout rate for the self-adminis­tered questionnaire is substantial and selective. Also, not all of the modules were employed every survey year, thus restricting the usefulness of pooled data to only some of the modules

Educational inequalities in diabetes mortality across Europe in the 2000s : the interaction with gender

To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders. Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and 'gender x educational rank'. An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0-3.9) in men versus 4.8 (95 % CI 3.2-7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated. Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.Peer reviewe

Evolution of educational inequalities in site-specific cancer mortality among Belgian men between the 1990s and 2000s using a “fundamental cause” perspective

Background: According to the "fundamental cause" theory, emerging knowledge on health-enhancing behaviours and technologies results in health disparities. This study aims to assess (trends in) educational inequalities in site-specific cancer mortality in Belgian men in the 1990s and the 2000s using this framework. Methods: Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality. The study population comprised all Belgian men aged 50-79 years during follow-up. Both absolute and relative inequality measures have been calculated. Results: Despite an overall downward trend in cancer mortality, educational differences are observed for the majority of cancer sites in the 2000s. Generally, inequalities are largest for mortality from preventable cancers. Trends over time in inequalities are rather stable compared with the 1990s. Conclusions: Educational differences in site-specific cancer mortality persist in the 2000s in Belgium, mainly for cancers related to behavioural change and medical interventions. Policy efforts focussing on behavioural change and healthcare utilization remain crucial in order to tackle these increasing inequalities.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Factors associated with return migration of first-generation immigrants in Belgium (2001-2011)

Belgium is a country with a long and diverse history of migration. Given the diverse context of immigration to Belgium, reasons for return migration will most likely vary as well. With this study, we want to quantify the return migration of Belgium's immigrants and assess whether socio-economic, sociodemographic and health factors are related to return migration. Individually linked census and register data comprising the total Belgian first-generation immigrant population aged 25+ were used. Age-standardized emigration rates (ASER) by migrant origin and gender were calculated for the period 2001-2011. Additionally, relative return migration differences were calculated by country of origin and gender, adjusted for age group, length of stay, household composition, socio-economic indicators (education, home ownership and employment status) and self-rated health in 2001. Return migration was most common among immigrants from Spanish descent and from the neighbouring countries and higher among men than among women. Return migration was highly selective in terms of older age, lower length of stay in Belgium, not living with a partner or children, being high-educated, unemployed and in good health. Key issues for future research include examining the reasons for return migration, identifying the country of destination and accounting for household characteristics

Trends in Belgian cause-specific mortality by migrant origin between the 1990s and the 2000s

Abstract Background Belgium has a large migrant community that is increasingly ageing. As migrants may have faced environmental and social exposures before, during and after migration, they may have experienced an accelerated epidemiological transition. Studying mortality differentials between the migrant and native population may therefore allow for a better understanding of the aetiology of diseases. While many studies have assessed migrant mortality, few have looked into the role of gender or the trend over time. Therefore, this study aims to probe into mortality differences between the native and migrant population for all major causes of death (COD) during the 1990s and 2000s. We will discriminate between all major migrant groups and men and women as they have different migration histories. Methods Individually linked data of the Belgian Census, the National Register and death certificates for the periods 1991–1997 and 2001–2008 were used. Migrant origin was based on both own and parents’ origin, hereby maximizing the population with migrant roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Both absolute and relative mortality differences by migrant origin were calculated for the most common COD. Results We generally observed a migrant advantage for overall, cause-specific and cancer-specific mortality, with infection-related cancer mortality being the only exception. The effect was particularly strong for lifestyle-related COD, non-western migrants, and men. Over time, mortality declined among native Belgian men and women, yet remained stable for several migrant groups. This converging trend was largely due to smoking and reduced reproductive behaviour among migrants. Conclusions The migrant mortality advantage stresses that there is room for improvement in the area of health in Belgium. Since the largest differences between native Belgians and migrants were observed for lifestyle-related diseases, and there is a tendency towards convergence of mortality over time, primary prevention tackling the most vulnerable groups remains crucial. Moreover, efforts should be made to ensure equal access to health care among the social and cultural strata

Migrant mortality differences in the 2000s in Belgium : interaction with gender and the role of socioeconomic position

BackgroundBelgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox.MethodsIndividually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001-2011 were used. Migrant origin was based on both own and parents' origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status.ResultsWe observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death.ConclusionsAdjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata

Socioeconomic position, population density and site-specific cancer mortality: A multilevel analysis of Belgian adults, 2001-2011

Our study explores the association between individual and neighborhood socioeconomic position (SEP) and all-cancer and site-specific cancer mortality. Data on all Belgian residents are retrieved from a population-based dataset constructed from the 2001 census linked to register data on emigration and mortality for 2001-2011. The study population contains all men and women aged 40 years or older during follow-up. Individual SEP is measured using education, employment status and housing conditions. Neighborhood SEP is measured by a deprivation index (in quintiles). Directly age-standardized mortality rates and multilevel Poisson models are used to estimate the association between individual SEP and neighborhood deprivation and mortality from all-cancer and cancer of the lung, colon and rectum, pancreas, prostate and female breast. The potential confounding role of population density is assessed using multilevel models as well. Our findings show an increase in mortality from all-cancer and site-specific cancer by decreasing level of individual SEP for both men and women. In addition, individuals living in highly deprived neighborhoods experience significantly higher mortality from all-cancer, lung cancer, pancreatic cancer and female colorectal cancer after controlling for individual SEP. Male colorectal and prostate cancer and female breast cancer are not associated with neighborhood deprivation. Population density acts as a confounder for female lung cancer only. Our study indicates that deprivation at both the individual and neighborhood level is associated with all-cancer mortality and mortality from several cancer sites. More research into the role of life-style related and clinical factors is necessary to gain more insight into causal pathway