Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

BACKGROUND: Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS: We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS: We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982–2008; Finnish women, 1985–2017; and Italian men, 1976–1999) were driven by faster mortality declines among the high-educated aged 65–84, and by mortality increases among the low-educated aged 30–59. The long-term decreases (British men, 1976–2008, and Italian women, 1972–2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30–54. CONCLUSION: Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

Background: Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. Methods: We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. Results: We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982–2008; Finnish women, 1985–2017; and Italian men, 1976–1999) were driven by faster mortality declines among the high-educated aged 65–84, and by mortality increases among the low-educated aged 30–59. The long-term decreases (British men, 1976–2008, and Italian women, 1972–2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30–54. Conclusion: Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30

Determinantes de gastos en salud durante el último año de vida de la población mexicana de 50 años o más

During the last year of life of the elderly health deteriorates the most, thus becoming the period of time when needs of medical services, personal care requirements and related costs are at highest. Using the Mexican Health and Aging Study, differences by sex in the determinants for out-of-pocket health expenditures during the last year of life of people 50 and over are discussed. Three levels of out-of-pocket expenses disbursement are contemplated: none, medium-low, and high. Controlling by sociodemographic variables, findings suggest that the number of hospital nights is the main determinant of health expenses, even above those related to diseases that are regarded as main causes of death. This fact impacts both out-of-pocket expences and the costs for medical institution. It is another issue in the over-hauling of the public health system.En las edades mayores el último año de vida es cuando la salud más se deteriora y es la etapa más demandante de atención médica y de cuidados. En consecuencia, también es la etapa más costosa. Se analizan diferencias por sexo en los determinantes de los gastos en salud por cuenta propia durante el último año de vida de personas de 50 o más, usando la encuesta del Estudio Nacional de Salud y Envejecimiento en México. Con estimaciones de gasto en tres niveles: ninguno, medio-bajo, y alto, controlando por variables sociodemográficas los resultados indican que el número de noches de hospital es la mayor determinante de gastos en salud, por encima de los relacionados con las enfermedades reconocidas como causa de muerte. Este factor tiene implicaciones en los gastos tanto por cuenta propia y como de las instituciones médicas. Son temas relevantes ante los cambios en el sistema de salud pública