101
|
The contribution of differences in adiposity to educational disparities in mortality in the United States. DEMOGRAPHIC RESEARCH 2018; 37:1735-1760. [PMID: 29326540 PMCID: PMC5759347 DOI: 10.4054/demres.2017.37.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There are large differences in life expectancy by educational attainment in the United States. Previous research has found obesity’s contribution to these differences to be small. Those findings may be sensitive to how obesity is estimated. METHODS This analysis uses discrete-time logistic regressions with data from the National Health and Nutrition Examination Survey (NHANES), pooled from 1988 to 1994 and 1999 to 2010, to estimate the contribution of differences in adiposity, or body fat, to educational differences in mortality. I show that results depend upon the measure of adiposity used: body mass index (BMI) at the time of survey or lifetime maximum BMI. RESULTS College graduates were less likely than high school graduates to be obese at the time of survey (25% vs. 34.6%, respectively) and were also less likely to have ever been obese (35.7% vs. 49.4%, respectively). Lifetime maximum BMI performed better than BMI at the time of survey in predicting mortality using criteria for model selection. Differences in maximum BMI were associated with between 10.3% and 12% of mortality differences between college graduates and all others, compared to between 3.3% and 4.6% for BMI at the time of survey. Among nonsmokers, between 18.4% and 27.6% of mortality differences between college graduates and all others were associated with differences in maximum BMI. CONTRIBUTION Adiposity is an overlooked contributor to educational differences in mortality. Previous findings that obesity does not contribute to educational disparities were based on BMI at the time of survey, which is less informative than maximum BMI. The contribution of adiposity to educational mortality differences will likely grow as smoking prevalence declines. Health surveys should collect information on weight history.
Collapse
|
102
|
Trends in Premature Mortality Due to Heart Failure by Autonomous Community in Spain: 1999 to 2013. ACTA ACUST UNITED AC 2018; 71:531-537. [PMID: 29331563 DOI: 10.1016/j.rec.2017.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major public health problem, and the prevalence increases with age. In Spain, there are considerable differences between autonomous communities. The aim of this study was to analyze trends in premature mortality due to HF between 1999 and 2013 in Spain by autonomous community. METHODS We analyzed data on mortality due to HF in Spanish residents aged 0 to 75 years by autonomous community between 1999 and 2013. Data were collected from files provided by the Spanish Statistics Office. Age-adjusted mortality rates were analyzed and the average annual percentage rate was estimated by Poisson models. RESULTS Mortality due to HF represented 10.9% of total mortality. In 2013, the national age-adjusted rate was 2.98 deaths in men and 1.29 deaths in women per 100 000 inhabitants, with an annual mean reduction of 2.27% and 4.53%, respectively. In men, average mortality showed the greatest reduction in Castile-La-Mancha (6.30%). In Cantabria, average mortality significantly increased (3.97%). In women, average mortality showed the greatest decrease in the Chartered Community of Navarre (15.17%). CONCLUSIONS During the study period, mortality due to HF showed an overall average decrease, both nationally and by autonomous community. This decrease was more pronounced in women than in men. Premature mortality significantly decreased in most-but not all-autonomous communities.
Collapse
|
103
|
Borges CA, Slater B, Santaliestra-Pasías AM, Mouratidou T, Huybrechts I, Widhalm K, Gottrand F, Manios Y, Jimenez-Pavón D, Valtueña J, Le Donne C, Marcos A, Molnar D, Castillo MJ, De Henauw S, Moreno LA. Dietary Patterns in European and Brazilian Adolescents: Comparisons and Associations with Socioeconomic Factors. Nutrients 2018; 10:E57. [PMID: 29315272 PMCID: PMC5793285 DOI: 10.3390/nu10010057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022] Open
Abstract
Associations between dietary patterns (DP) and socioeconomic factors have been little explored in adolescents. The aim of this study was to identify DP in European and Brazilian adolescents and to investigate their associations with a range of socioeconomic indicators. Adolescents from the HELENA-study and the Household Budget Survey were analyzed. Factor analysis was used to obtain DP. Linear regression was used to examine the association between DP and SES. In Europeans, the Western DP was associated with low education of the mother, high socioeconomic status (boys), older age (boys), and living in cities of the Northern Europe; in Brazilians, the Western DP was associated with high secondary education of the mother, high socioeconomic status and living in Southern areas of the country. The Traditional European DP, in both genders, was associated with high secondary education of the mother and inversely associated with a high socioeconomic status; the Traditional Brazilian DP, was associated with university level education of the mother and older age (boys). The association between DP and socioeconomic factors is relevant for the understanding of food-related practices and highlight the importance of performing a complete assessment of the socioeconomic influence in adolescent's DP from developed and developing countries.
Collapse
Affiliation(s)
- Camila Aparecida Borges
- School of Public Health, Department of Nutrition, University of Sao Paulo Avenue Dr. Arnaldo 715, Sao Paulo 01246-904, Brazil;
| | - Betzabeth Slater
- School of Public Health, Department of Nutrition, University of Sao Paulo Avenue Dr. Arnaldo 715, Sao Paulo 01246-904, Brazil;
| | - Alba Maria Santaliestra-Pasías
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Agroalimentary Institute of Aragon (IA2), Institute of Health Research of Aragon (IIS Aragon), Center for Biomedical Research Network Pathophysiology of Obesity and Nutrition (CIBERObn), 50009 Zaragoza, Spain; (A.M.S.-P.); (T.M.); (L.A.M.)
| | - Theodora Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Agroalimentary Institute of Aragon (IA2), Institute of Health Research of Aragon (IIS Aragon), Center for Biomedical Research Network Pathophysiology of Obesity and Nutrition (CIBERObn), 50009 Zaragoza, Spain; (A.M.S.-P.); (T.M.); (L.A.M.)
| | - Inge Huybrechts
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France;
| | - Kurt Widhalm
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria;
| | - Frédéric Gottrand
- Inserm U955, IFR 114/IMPRT, Faculty of Medicine, University Lille 2, F-59037 Lille, France;
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Athens, Greece;
| | - David Jimenez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11519 Cádiz, Spain;
| | - Jara Valtueña
- ImFINE Research Group, Department of Health and Human Performance, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro, 7, 28040 Madrid, Spain;
| | - Cinzia Le Donne
- Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178 Rome, Italy;
| | - Ascensión Marcos
- Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), C/Jose Antonio Novais 10, 28040 Madrid, Spain;
| | - Dénes Molnar
- Department of Pediatrics, University of Pécs, Medical School, József A. u. 7., 7623 Pécs, Hungary;
| | - Manuel J. Castillo
- Department of Medical Physiology, Faculty of Medicine, University of Granada, Avenida Madrid, 12, 18012 Granada, Spain;
| | - Stefaan De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, 9000 Ghent, Belgium;
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Agroalimentary Institute of Aragon (IA2), Institute of Health Research of Aragon (IIS Aragon), Center for Biomedical Research Network Pathophysiology of Obesity and Nutrition (CIBERObn), 50009 Zaragoza, Spain; (A.M.S.-P.); (T.M.); (L.A.M.)
| |
Collapse
|
104
|
Mangrio E, Sjögren Forss K. Refugees' experiences of healthcare in the host country: a scoping review. BMC Health Serv Res 2017; 17:814. [PMID: 29216876 PMCID: PMC5721651 DOI: 10.1186/s12913-017-2731-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background During the last years, Europe experienced an increase in immigration due to a variety of worldwide wars and conflicts, which in turn resulted in a greater number of physical and mental health issues present among the refugees. These factors place high demands not only on the refugees, but also on healthcare professionals who meet the refugees in different situations. Information about the refugees’ experiences of the healthcare systems in their host countries is urgently needed to improve the quality of healthcare delivered, as well as to provide opportunities for better access. The aim of this scoping review is to compile research about the experiences that the refugees have with the healthcare systems in their host countries. Methods This study was conducted as a scoping review and the methodology is derived from Levac et al. and with inspiration from the framework of Arksey & O’Malley. A systematic article search was done in Medline, Cinahl and Psychinfo. A total of 619 articles were found in the search and finally 26 articles met the inclusion criteria and were included. Results The results show that communication between healthcare professionals and refugees is important, however, insufficient language knowledge acts as an effective communication barrier. There is a need for more information to be given to the refugees about the reception country’s healthcare system in both oral and written formats, as well as the right to healthcare. Support from healthcare professionals is also important for refugees to have a positive experience with healthcare. In some of the studies included, refugees experienced discrimination due to low proficiency in the language of the host country, and/or because of their race or accent, which shows that culturally appropriate healthcare is needed for them. Conclusions Since refugees are suffering from poor mental and physical health and could therefore be at a greater risk of morbidity and mortality in comparison to the rest of the population of the host country, there is an urgent need for improvements in communication, interpretation, support, and deliverance of culturally appropriate healthcare.
Collapse
Affiliation(s)
- Elisabeth Mangrio
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden. .,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden.
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden
| |
Collapse
|
105
|
Hansen T, Slagsvold B, Veenstra M. Educational inequalities in late-life depression across Europe: results from the generations and gender survey. Eur J Ageing 2017; 14:407-418. [PMID: 29180946 PMCID: PMC5684038 DOI: 10.1007/s10433-017-0421-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study explores country- and gender-stratified educational differences in depression among older adults from 10 European countries. We examine inequalities in both absolute (prevalence differences) and relative (odds ratios) terms and in bivariate and multivariate models. We use cross-sectional, nationally representative data from the generations and gender survey. The analysis comprises 27,331 Europeans aged 60-80. Depression is measured with a seven-item version of the Center for Epidemiologic Studies Depression scale. Findings show considerable between-country heterogeneity in late-life depression. An East-West gradient is evident, with rates of depression up to three times higher in Eastern European than in Scandinavian countries. Rates are about twice as high among women than men in all countries. Findings reveal marked absolute educational gaps in depression in all countries, yet the gaps are larger in weaker welfare states. This pattern is less pronounced for the relative inequalities, especially for women. Some countries observe similar relative inequalities but vastly different absolute inequalities. We argue that the absolute differences are more important for social policy development and evaluation. Educational gradients in depression are strongly mediated by individual-level health and financial variables. Socioeconomic variation in late-life depression is greater in countries with poorer economic development and welfare programs.
Collapse
Affiliation(s)
- Thomas Hansen
- Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Britt Slagsvold
- Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Marijke Veenstra
- Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| |
Collapse
|
106
|
Celeste RK, Fritzell J. Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up. J Epidemiol Community Health 2017; 72:160-167. [PMID: 29175868 PMCID: PMC5800356 DOI: 10.1136/jech-2017-209123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing. METHODS Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906-1915 (n=899), 1925-1934 (n=906), 1944-1953 (n=1154), 1957-1966 (n=923) and 1970-1981 (n=1199). The participants were 15-62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations. RESULTS All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45-64 years, and then they decreased. Relative inequalities were large already in individuals aged 15-25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life. CONCLUSION Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.
Collapse
Affiliation(s)
- Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| |
Collapse
|
107
|
Repeatedly measured material and behavioral factors changed the explanation of socioeconomic inequalities in all-cause mortality. J Clin Epidemiol 2017; 91:137-145. [DOI: 10.1016/j.jclinepi.2017.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/09/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
|
108
|
Renard F, Devleesschauwer B, Gadeyne S, Tafforeau J, Deboosere P. Educational inequalities in premature mortality by region in the Belgian population in the 2000s. Arch Public Health 2017; 75:44. [PMID: 29046785 PMCID: PMC5641991 DOI: 10.1186/s13690-017-0212-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population. METHODS Residents with Belgian nationality at birth registered in the census 2001 aged 25-64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death. RESULTS Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences. CONCLUSIONS For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes.
Collapse
Affiliation(s)
- Françoise Renard
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| |
Collapse
|
109
|
Søndergaard G, Dalton SO, Mortensen LH, Osler M. Educational inequality in cardiovascular diseases: a sibling approach. Scand J Public Health 2017; 46:83-91. [PMID: 28992724 DOI: 10.1177/1403494817734775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases, ischaemic heart disease and stroke, respectively, were explained by family factors shared by siblings. METHODS The study population included all individuals born in Denmark between 1950 and 1979 who had at least one full sibling born in the same period. Using Cox regression, data were analysed in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families. RESULTS A lower educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate of ischaemic heart disease among women less than 45 years who had a primary school education was 94% (hazard ratio 1.94 (1.78-2.12) higher than among those with a vocational education, while it attenuated to 51% (hazard ratio 1.51 (1.34-1.71)) in the within-sibship analysis. CONCLUSIONS Confounding from factors shared by siblings explained the associations between education and the cardiovascular disease outcomes but to varying degrees. This should be taken into account when planning interventions aimed at reducing educational inequalities in the development of cardiovascular disease, ischaemic heart disease and stroke.
Collapse
Affiliation(s)
- Grethe Søndergaard
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Denmark
| | | | | | - Merete Osler
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Denmark
| |
Collapse
|
110
|
Tanaka H, Toyokawa S, Tamiya N, Takahashi H, Noguchi H, Kobayashi Y. Changes in mortality inequalities across occupations in Japan: a national register based study of absolute and relative measures, 1980-2010. BMJ Open 2017; 7:e015764. [PMID: 28877942 PMCID: PMC5588999 DOI: 10.1136/bmjopen-2016-015764] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Changes in mortality inequalities across socioeconomic groups have been a substantial public health concern worldwide. We investigated changes in absolute/relative mortality inequalities across occupations, and the contribution of different diseases to inequalities in tandem with the restructuring of the Japanese economy. METHODS Using complete Japanese national death registries from 5 year intervals (1980-2010), all cause and cause specific age standardised mortality rates (ASMR per 100 000 people standardised using the Japanese standard population in 1985, aged 30-59 years) across 12 occupations were computed. Absolute and relative inequalities were measured in ASMR differences (RDs) and ASMR ratios (RRs) among occupations in comparison with manufacturing workers (reference). We also estimated the changing contribution of different diseases by calculating the differences in ASMR change between 1995 and 2010 for occupations and reference. RESULTS All cause ASMRs tended to decrease in both sexes over the three decades except for male managers (increased by 71% points, 1995-2010). RDs across occupations were reduced for both sexes (civil servants 233.5 to -1.9 for men; sales workers 63.3 to 4.5 for women) but RRs increased for some occupations (professional workers 1.38 to 1.70; service workers 2.35 to 3.73) for men and decreased for women from 1980 to 2010. Male relative inequalities widened among farmer, fishery and service workers, because the percentage declines were smaller in these occupations. Cerebrovascular disease and cancer were the main causes of the decrease in mortality inequalities among sexes but the incidence of suicide increased among men, thereby increasing sex related inequalities. CONCLUSIONS Absolute inequality trends in mortality across occupations decreased in both sexes, while relative inequality trends were heterogeneous in Japan. The main drivers of narrowing and widening mortality inequalities were cerebrovascular disease and suicide, respectively. Future public health efforts will benefit from eliminating residual inequalities in mortality by considering the contribution of the causes of death and socioeconomic status stratification.
Collapse
Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideto Takahashi
- Research Managing Director, National Institute of Public Health, Wako, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
111
|
Mackenbach JP, Looman CWN, Artnik B, Bopp M, Deboosere P, Dibben C, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Regidor E, Rychtaříková J, de Gelder R. 'Fundamental causes' of inequalities in mortality: an empirical test of the theory in 20 European populations. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1117-1133. [PMID: 28369947 DOI: 10.1111/1467-9566.12562] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The 'fundamental causes' theory stipulates that when new opportunities for lowering mortality arise, higher socioeconomic groups will benefit more because of their greater material and non-material resources. We tested this theory using harmonised mortality data by educational level for 22 causes of death and 20 European populations from the period 1980-2010. Across all causes and populations, mortality on average declined by 2.49 per cent (95%CI: 2.04-2.92), 1.83% (1.37-2.30) and 1.34% (0.89-1.78) per annum among the high, mid and low educated, respectively. In 69 per cent of cases of declining mortality, mortality declined faster among the high than among the low educated. However, when mortality increased, less increase among the high educated was found in only 46 per cent of cases. Faster mortality decline among the high educated was more manifest for causes of death amenable to intervention than for non-amenable causes. The difference in mortality decline between education groups was not larger when income inequalities were greater. While our results provide support for the fundamental causes theory, our results suggest that other mechanisms than the theory implies also play a role.
Collapse
Affiliation(s)
| | | | - Barbara Artnik
- Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh
| | | | - Katalin Kovács
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Stockholm, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | | | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Spain
| | - Jitka Rychtaříková
- Department of Demography and Geodemography, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Rianne de Gelder
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|
112
|
Lisauskienė I, Garuolienė K, Gulbinovič J. Utilization of cardiovascular medicines and cardiovascular mortality in Lithuania, Sweden and Norway in 2003-2012. MEDICINA-LITHUANIA 2017; 53:259-267. [PMID: 28844562 DOI: 10.1016/j.medici.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this ecological study was to evaluate whether any changes in cardiovascular (CV) medicine utilization, population, socioeconomic and health system factors were associated with CV mortality in Lithuania, Sweden and Norway in 2003-2012. MATERIALS AND METHODS CV drug utilization was calculated using the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology and expressed as a number of DDD per 1000 inhabitants per day (DDD/TID). The CV age-standardized death rate (CV-SDR) and risk factors data were obtained from the WHO, EUROSTAT, and FAOSTAT databases. The multiple linear regression model was used for modeling outcome measures - the relationship between the CV-SDR and CV medicine utilization including socioeconomic (GDP, unemployment and divorce rate), population (alcohol consumption, smoking and amount of kcal per day, consumption of fruit and vegetables, health status self-evaluation) and health system factors (number of hospital beds, practicing physicians and health care expenditure). RESULTS The higher CV medicine utilization in Sweden (307-455 DDD/TID, P<0.001) and Norway (306-394 DDD/TID, P<0.001) was associated with a definite decline in CV-SDR (in Norway from 215 to 146 and in Sweden from 233 to 174). In Lithuania, the increasing but lower consumption of CV medicines (135-360 DDD/TID, P<0.001) and twice higher CV-SDR (from 541 to 447) was registered. A significant inverse correlation was observed between CV-SDR and DDD/TID. We found a strong association between the DDD/TID and the CV-SDR (R2=0.67, P<0.001). There was a strong correlation between CV-SDR and nine factors (P<0.05), except the number of practicing physicians, amount of kcal per day. There was a strong correlation between DDD/TID and nine factors (P<0.05), except the unemployment rate and amount of kcal per day. Association between an increase in the use of medicines and a decrease in CV-SDR was stronger in the case of higher alcohol consumption, higher number of available beds in hospitals and the lower unemployment rate. CONCLUSIONS We confirmed the strong negative correlation between CV medicine utilization and CV mortality in all countries. The strong correlation was found between CV-SDR and nine factors, also between the use of CV medicines and nine factors. The impact of factors on the medicines induced decrease in CV-SDR showed the stronger influence in case of lower unemployment, higher alcohol consumption and higher number of beds for hospitalization.
Collapse
Affiliation(s)
- Ingrida Lisauskienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; The Ministry of Health, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; State Medicines Control Agency under the Ministry of Health, Vilnius, Lithuania
| |
Collapse
|
113
|
Mackenbach JP, Bopp M, Deboosere P, Kovacs K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, de Gelder R. Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries. Health Place 2017; 47:44-53. [PMID: 28738213 DOI: 10.1016/j.healthplace.2017.07.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 06/24/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970-2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy.
Collapse
Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katalin Kovacs
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - Mall Leinsalu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
| | | | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Rianne de Gelder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| |
Collapse
|
114
|
Individual- and area-level characteristics associated with alcohol-related mortality among adult Lithuanian males: A multilevel analysis based on census-linked data. PLoS One 2017; 12:e0181622. [PMID: 28732032 PMCID: PMC5521820 DOI: 10.1371/journal.pone.0181622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/03/2017] [Indexed: 01/10/2023] Open
Abstract
Background Although excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood. Aims We assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30–64. Methods Our analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR). Results The selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6–2.2), divorced (MRR = 2.6, CI:2.3–2.9), and widowed (MRR = 2.4, CI: 1.8–3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4–2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4–5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1–1.6) and Polish (MRR = 1.8, CI: 1.5–2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables—i.e., the share of ethnic minorities in the population and the election turnout—have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level. Conclusions The huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.
Collapse
|
115
|
Vanthomme K, Vandenheede H, Hagedoorn P, Gadeyne S. Evolution of educational inequalities in site-specific cancer mortality among Belgian men between the 1990s and 2000s using a "fundamental cause" perspective. BMC Cancer 2017; 17:470. [PMID: 28679369 PMCID: PMC5498997 DOI: 10.1186/s12885-017-3461-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/27/2017] [Indexed: 12/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Katrien Vanthomme
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hadewijch Vandenheede
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Paulien Hagedoorn
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| |
Collapse
|
116
|
Teng AM, Atkinson J, Disney G, Wilson N, Blakely T. Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person-years follow-up 1981-2011. Int J Cancer 2017; 140:1306-1316. [PMID: 27925183 DOI: 10.1002/ijc.30555] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022]
Abstract
Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high-income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow-up cancer incidence and mortality, respectively. Age- and ethnicity-standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981-84 to 2006-11, peaking in 1991-94 for men and in 1996-99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981-84 to 33% in 2006-11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all-cause mortality has expanded in this high-income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes.
Collapse
Affiliation(s)
- Andrea M Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George Disney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
117
|
Hoebel J, Finger JD, Kuntz B, Kroll LE, Manz K, Lange C, Lampert T. Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012. BMC Public Health 2017; 17:547. [PMID: 28587641 PMCID: PMC5461755 DOI: 10.1186/s12889-017-4478-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s. METHODS Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25-69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively. RESULTS Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25-0.35; RII = 2.08, 95% CI = 1.83-2.38) and 2012 (SII = 0.41, 95% CI = 0.37-0.45; RII = 3.44, 95% CI = 3.03-3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly. CONCLUSIONS The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.
Collapse
Affiliation(s)
- Jens Hoebel
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Jonas D Finger
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Benjamin Kuntz
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Lars E Kroll
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Kristin Manz
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Cornelia Lange
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Thomas Lampert
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| |
Collapse
|
118
|
Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study. Health Place 2017; 45:189-198. [PMID: 28412595 DOI: 10.1016/j.healthplace.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.
Collapse
Affiliation(s)
- Maria Holst Algren
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Carsten Kronborg Bak
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| |
Collapse
|
119
|
Kulhánová I, Menvielle G, Hoffmann R, Eikemo TA, Kulik MC, Toch-Marquardt M, Deboosere P, Leinsalu M, Lundberg O, Regidor E, Looman CWN, Mackenbach JP. The role of three lifestyle risk factors in reducing educational differences
in ischaemic heart disease mortality in Europe. Eur J Public Health 2017; 27:203-210. [PMCID: PMC6284353 DOI: 10.1093/eurpub/ckw104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios—the upward levelling scenario and the more realistic best practice country scenario. Methods: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30–79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s. Results: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated. Conclusion: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.
Collapse
Affiliation(s)
- Ivana Kulhánová
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
| | - Gwenn Menvielle
- Sorbonne Universités, UPMC University Paris 06, INSERM, Institut Pierre
Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Rasmus Hoffmann
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
| | - Terje A Eikemo
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
- Department of Sociology and Political Science, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
| | - Margarete C Kulik
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
| | - Marlen Toch-Marquardt
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
- Department of Sociology and Political Science, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels,
Belgium
| | - Mall Leinsalu
- Stockholm Centre on Health of Societies in Transition, Södertörn
University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for
Health Development, Tallin, Estonia
| | - Olle Lundberg
- Centre for Health Equity Studies, Stockholm University, Stockholm,
Sweden
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad
Complutense de Madrid, Madrid, Spain
| | - Caspar W N Looman
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, Rotterdam, The
Netherlands
| | | |
Collapse
|
120
|
Storeng SH, Krokstad S, Westin S, Sund ER. Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway. Scand J Public Health 2017; 46:124-131. [PMID: 29191110 DOI: 10.1177/1403494817695911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Norway is experiencing a rising life expectancy combined with an increasing dependency ratio - the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups. METHODS Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects. RESULTS During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased. CONCLUSIONS The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.
Collapse
Affiliation(s)
- Siri H Storeng
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Steinar Krokstad
- 2 HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,3 Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Steinar Westin
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- 2 HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,4 Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| |
Collapse
|
121
|
Richardson EA, Moon G, Pearce J, Shortt NK, Mitchell R. Multi-scalar influences on mortality change over time in 274 European cities. Soc Sci Med 2017; 179:45-51. [PMID: 28254658 DOI: 10.1016/j.socscimed.2017.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
Understanding determinants of urban health is of growing importance. Factors at multiple scales intertwine to influence health in cities but, with the growing autonomy of some cities from their countries, city population health may be becoming more a matter for city-level rather than national-level policy and action. We assess the importance of city, country, and macroregional (Western and East-Central Europe) scales to mortality change over time for 274 cities (population 80 million) from 27 European countries. We then investigate whether mortality changes over time are related to changes in city-level affluence. Using Urban Audit data, all-age all-cause standardised mortality ratios (SMRs) for males and females were calculated at three time points (wave one 1999-2002, wave two 2003-2006, and wave three 2007-2009) for each city. Multilevel regression was used to model the SMRs as a function of survey wave and city region gross domestic product (GDP) per 1000 capita. SMRs declined over time and the substantial East-West gap narrowed slightly. Variation at macroregion and country scales characterised SMRs for women in Western and East-Central European cities, and SMRs for men in East-Central European cities. Between-city variation was evident for male SMRs in Western Europe. Changes in city-region GDP per capita were not associated with changes in mortality over the study period. Our results show how geographical scales differentially impact urban mortality. We conclude that changes in urban health should be seen in both city and wider national and macroregional contexts.
Collapse
Affiliation(s)
- Elizabeth A Richardson
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK.
| | - Graham Moon
- Geography and Environment, University of Southampton, University Road, Southampton SO17 1BJ, UK.
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK.
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK.
| | - Richard Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland G12 8RZ, UK.
| |
Collapse
|
122
|
von dem Knesebeck O, Vonneilich N, Lüdecke D. Income and functional limitations among the aged in Europe: a trend analysis in 16 countries. J Epidemiol Community Health 2017; 71:584-591. [DOI: 10.1136/jech-2016-208369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/11/2016] [Accepted: 12/14/2016] [Indexed: 11/03/2022]
|
123
|
de Gelder R, Menvielle G, Costa G, Kovács K, Martikainen P, Strand BH, Mackenbach JP. Long-term trends of inequalities in mortality in 6 European countries. Int J Public Health 2016; 62:127-141. [PMID: 27942745 PMCID: PMC5288439 DOI: 10.1007/s00038-016-0922-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/01/2016] [Accepted: 11/10/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives We aimed to assess whether trends in inequalities in mortality during the period 1970–2010 differed between Finland, Norway, England and Wales, France, Italy (Turin) and Hungary. Methods Total and cause-specific mortality data by educational level and, if available, occupational class were collected and harmonized. Both relative and absolute measures of inequality in mortality were calculated. Results In all countries except Hungary, all-cause mortality declined strongly over time in all socioeconomic groups. Relative inequalities in all-cause mortality generally increased, but more so in Hungary and Norway than elsewhere. Absolute inequalities often narrowed, but went up in Hungary and Norway. As a result of these trends, Hungary (where inequalities in mortality where almost absent in the 1970s) and Norway (where inequalities in the 1970s were among the smallest of the six countries in this study) now have larger inequalities in mortality than the other four countries. Conclusions While some countries have experienced dramatic setbacks, others have made substantial progress in reducing inequalities in mortality. Electronic supplementary material The online version of this article (doi:10.1007/s00038-016-0922-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rianne de Gelder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Gwenn Menvielle
- UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, Paris, France
| | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Turin, Italy
| | | | | | - Bjørn Heine Strand
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | |
Collapse
|
124
|
Hämäläinen RM, Sandu P, Syed AM, Jakobsen MW. An evaluation of equity and equality in physical activity policies in four European countries. Int J Equity Health 2016; 15:191. [PMID: 27881131 PMCID: PMC5122031 DOI: 10.1186/s12939-016-0481-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background There is strong research evidence on the importance of health equity and equality for wellbeing in societies. As chronic non-communicable diseases are widespread, the positive impact of physical activity (PA) on health has gained importance. However, PA at the population level is far from optimal. PA depends not only on individual factors, but also on policies for PA in sport, health, transport, education and other sectors, on social and cultural factors, and on the environment. Addressing health inequalities and inequities in PA promotion policies could benefit from policy development processes based on partnership and collaboration between various sectors, researchers, practitioners and policy makers (= cross-sectoral, evidence-informed policy making). The objective of this article is to describe how equity and equality was addressed in PA policies in four EU member states (Denmark, Finland, Romania and England), who were partners in the REPOPA project (www.repopa.eu, EC/FP7/Health Research/GA 281532). Methods Content analysis of 14 PA policies and 61 interviews were undertaken between 2012 and 2013 with stakeholders involved in developing PA policies in partner countries. Results Even though specific population subgroups were mentioned in the policy documents analysed, they were not necessarily defined as vulnerable populations nor was there a mention of additional emphasis to support such groups from being marginalised by the policy due to inequity or inequality. There were no clear objectives and activities in the analysed policies suggesting commitment of additional resources in favour of such groups. Addressing equity and equality were often not included in the core aims of the policies analysed; these aspects were mentioned in the background of the policy documents analysed, without being explicitly stated in the aims or activities of the policies. In order to tackle health inequities and inequalities and their consequences on the health status of different population subgroups, a more instrumental approach to health equality and equity in PA promotion policies is needed. Policies should include aims to address health inequalities and inequities as fundamental objectives and also consider opportunities to allocate resources to reduce them for identified groups in this regard: the socially excluded, the remote, and the poor. Conclusions The inclusion of aspects related to health inequalities and inequities in PA policies needs monitoring, evaluation and transparent accountability if we are to see the best gains in health of socially disadvantaged group. To tackle health inequities and inequalities governance structures need to take into consideration proportionate universalism. Thus, to achieve change in the social determinants of health, policy makers should pay attention to PA and proportionally invest for universal access to PA services. PA promotion advocates should develop a deeper awareness of political and policy structures and require more equity and equality in PA policies from those who they seek to influence, within specific settings for policy making and developing the policy agenda.
Collapse
Affiliation(s)
| | - Petru Sandu
- Department of Public Health, Babes-Bolyai University, Pandurilor 7, Cluj-Napoca, Romania
| | - Ahmed M Syed
- National Health Service, 80 London Road, London, SE1 6LH, UK
| | - Mette W Jakobsen
- Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, 6700, Esbjerg, Denmark
| |
Collapse
|
125
|
Renard F, Gadeyne S, Devleesschauwer B, Tafforeau J, Deboosere P. Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths. J Epidemiol Community Health 2016; 71:371-380. [PMID: 27885048 DOI: 10.1136/jech-2016-208370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/21/2016] [Accepted: 11/04/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global inequality. METHODS The 1991 and 2001 Belgian censuses were linked with cause-of-death data, each yielding a study population of over 5 million individuals aged 25-64, followed up for 5 years. Age-standardised mortality rates (ASMR) were computed by educational level (EL) and cause. Inequalities were measured through rate differences (RDs), rate ratios (RRs) and population attributable fractions (PAFs). We analysed changes in educational inequalities between the 1990s and the 2000s, and decomposed the PAF into the main causes of death. RESULTS All-cause and avoidable ASMR decreased in all ELs and both sexes. Lung cancer, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and suicide in men, and IHD, stroke, lung cancer and COPD in women had the highest impact on population mortality. RDs decreased in men but increased in women. RRs and PAFs increased in both sexes, albeit more in women. In men, the impact of lung cancer and COPD inequalities on population mortality decreased while that of suicide and IHD increased. In women, the impact of all causes except IHD increased. CONCLUSION Absolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. The PAFs decomposition revealed that targeting mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women would have the largest impact at population level.
Collapse
Affiliation(s)
- Françoise Renard
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Section Social Research, Free University of Brussels, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Section Social Research, Free University of Brussels, Brussels, Belgium
| |
Collapse
|
126
|
Bahk J, Lynch JW, Khang YH. Forty years of economic growth and plummeting mortality: the mortality experience of the poorly educated in South Korea. J Epidemiol Community Health 2016; 71:282-288. [PMID: 27707841 DOI: 10.1136/jech-2016-207707] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/06/2016] [Accepted: 09/17/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND South Korea has experienced rapid economic development and a substantial increase in life expectancy in an extremely short period. Whether this rapid development has been able to adequately address inequalities in health in South Korea may have important policy implications. This paper explores long-term trends in inequalities in mortality related to education in South Korea between 1970 and 2010. METHODS We used secondary data on population size and deaths in 1970 and 1980 from a previously published study, and census and death certificate data from Statistics Korea from 1990, 1995, 2000, 2005 and 2010. Trends in age-standardised mortality rates for men and women aged 25-64 according to education, as well as the rate ratio (RR), rate difference (RD), relative index of inequality (RII) and slope index of inequality (SII), were examined over the period 1970-2010. RESULTS Despite overall mortality declines of 70-80% in the past 4 decades, educational inequalities have increased or been stagnant. There was minimal decline in mortality since 1970 in South Koreans with only a primary or lower level of education. The RR and RD between tertiary education and primary or lower education increased over the study period, while the RII and the SII in both genders remained stable. CONCLUSIONS The South Korean experience over the past 40 years suggests that plummeting mortality rates and huge advances in education at the population level do not translate into reduced educational inequalities in mortality.
Collapse
Affiliation(s)
- Jinwook Bahk
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
127
|
Pikala M, Burzyn´ska M, Pikala R, Bryła M, Maniecka-Bryła I. Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study. BMJ Open 2016; 6:e011501. [PMID: 27678532 PMCID: PMC5051391 DOI: 10.1136/bmjopen-2016-011501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/21/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011. METHODS The analysis included all deaths among inhabitants of Poland, aged 25-64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression. RESULTS The SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9). CONCLUSIONS Educational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.
Collapse
Affiliation(s)
- Małgorzata Pikala
- Department of Epidemiology and Biostatistics, The Chair of Social and Preventive Medicine of the Medical University of Lodz, Lodz, Poland
| | - Monika Burzyn´ska
- Department of Epidemiology and Biostatistics, The Chair of Social and Preventive Medicine of the Medical University of Lodz, Lodz, Poland
| | - Robert Pikala
- Faculty of Technical Physics, Information Technology and Applied Mathematics, Lodz University of Technology, Lodz, Poland
| | - Marek Bryła
- Department of Social Medicine, The Chair of Social and Preventive Medicine of the Medical University of Lodz, Lodz, Poland
| | - Irena Maniecka-Bryła
- Department of Epidemiology and Biostatistics, The Chair of Social and Preventive Medicine of the Medical University of Lodz, Lodz, Poland
| |
Collapse
|
128
|
Hu Y, van Lenthe FJ, Judge K, Lahelma E, Costa G, de Gelder R, Mackenbach JP. Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries. BMC Public Health 2016; 16:865. [PMID: 27558269 PMCID: PMC4995654 DOI: 10.1186/s12889-016-3505-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme. METHODS Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position. RESULTS After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries. CONCLUSIONS In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.
Collapse
Affiliation(s)
- Yannan Hu
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ken Judge
- Department of Health, University of Bath, Bath, UK
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| |
Collapse
|
129
|
Marí-Dell’Olmo M, Gotsens M, Palència L, Rodríguez-Sanz M, Martinez-Beneito MA, Ballesta M, Calvo M, Cirera L, Daponte A, Domínguez-Berjón F, Gandarillas A, Goñi NI, Martos C, Moreno-Iribas C, Nolasco A, Salmerón D, Taracido M, Borrell C. Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities. BMC Public Health 2016; 16:663. [PMID: 27473140 PMCID: PMC4966571 DOI: 10.1186/s12889-016-3190-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996-1998 and 2005-2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. METHODS Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996-1998 and 2005-2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). RESULTS For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12-1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09-1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05-1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02-1.06 in the 2nd period). CONCLUSIONS In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.
Collapse
Affiliation(s)
- Marc Marí-Dell’Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Laia Palència
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Miguel A. Martinez-Beneito
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Fundación para el fomento de la investigación sanitaria y biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Mónica Ballesta
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Montse Calvo
- Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo, Gobierno Vasco, Vitoria-Gasteiz, Spain
| | - Lluís Cirera
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Antonio Daponte
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | | | - Ana Gandarillas
- Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain
| | - Natividad Izco Goñi
- Registro de Mortalidad, Consejería de Salud y Servicios Sociales, La Rioja, Spain
| | - Carmen Martos
- Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de Navarra, Pamplona, Navarra Spain
| | - Andreu Nolasco
- Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Diego Salmerón
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Margarita Taracido
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
130
|
Hoffmann R, Hu Y, de Gelder R, Menvielle G, Bopp M, Mackenbach JP. The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries. Int J Equity Health 2016; 15:103. [PMID: 27390929 PMCID: PMC4938956 DOI: 10.1186/s12939-016-0390-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. Methods We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35–79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. Results The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. Conclusions We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0390-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rasmus Hoffmann
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands.
| | - Yannan Hu
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
| | - Rianne de Gelder
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
| | - Gwenn Menvielle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
| |
Collapse
|
131
|
Heckley G, Gerdtham UG, Kjellsson G. A general method for decomposing the causes of socioeconomic inequality in health. JOURNAL OF HEALTH ECONOMICS 2016; 48:89-106. [PMID: 27137844 DOI: 10.1016/j.jhealeco.2016.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 03/13/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
Collapse
Affiliation(s)
- Gawain Heckley
- Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden.
| | - Ulf-G Gerdtham
- Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden; Department of Economics, Lund University, Lund, Sweden
| | - Gustav Kjellsson
- Department of Economics, University of Gothenburg, Gothenburg, Sweden; Centre of Health Economics at Gothenburg University (CHEGU), Gothenburg, Sweden
| |
Collapse
|
132
|
Gregoraci G, van Lenthe FJ, Artnik B, Bopp M, Deboosere P, Kovács K, Looman CWN, Martikainen P, Menvielle G, Peters F, Wojtyniak B, de Gelder R, Mackenbach JP. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990-2004. Tob Control 2016; 26:260-268. [PMID: 27122064 DOI: 10.1136/tobaccocontrol-2015-052766] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. METHODS We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. RESULTS In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between -1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. CONCLUSIONS In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.
Collapse
Affiliation(s)
- G Gregoraci
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Medical and Biological Sciences, University of Udine, Institute of Hygiene and Clinical Epidemiology, Udine, Italy
| | - F J van Lenthe
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Artnik
- Department of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Bopp
- Department of Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - P Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Kovács
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - C W N Looman
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P Martikainen
- Department of Sociology, University of Helsinki, Helsinki, Finland
| | - G Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - F Peters
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Wojtyniak
- Department Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - R de Gelder
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J P Mackenbach
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | |
Collapse
|
133
|
Layte R, Banks J. Socioeconomic differentials in mortality by cause of death in the Republic of Ireland, 1984-2008. Eur J Public Health 2016; 26:451-8. [PMID: 27069003 DOI: 10.1093/eurpub/ckw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT/PROBLEM Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. OBJECTIVE This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. METHODS This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. RESULTS SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. CONCLUSIONS These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption.
Collapse
Affiliation(s)
- Richard Layte
- 1 Department of Sociology, Trinity College Dublin and the Economic and Social Research Institute, Dublin, Ireland
| | - Joanne Banks
- 2 Economic and Social Research Institute and Adjunct Research Associate, Department of Sociology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
134
|
Mackenbach JP, Kulhánová I, Artnik B, Bopp M, Borrell C, Clemens T, Costa G, Dibben C, Kalediene R, Lundberg O, Martikainen P, Menvielle G, Östergren O, Prochorskas R, Rodríguez-Sanz M, Strand BH, Looman CWN, de Gelder R. Changes in mortality inequalities over two decades: register based study of European countries. BMJ 2016; 353:i1732. [PMID: 27067249 PMCID: PMC4827355 DOI: 10.1136/bmj.i1732] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. DESIGN Register based study. DATA SOURCE Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). SETTING All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. RESULTS Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. CONCLUSIONS Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.
Collapse
Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Ivana Kulhánová
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Barbara Artnik
- Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Tom Clemens
- School of Geosciences, University of Edinburgh, Edinburgh
| | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Italy
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh
| | | | - Olle Lundberg
- Center for Health Equity Studies, Stockholm, Sweden Department of Health Sciences, Mid Sweden University, Östersund
| | | | - Gwenn Menvielle
- Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | | | | | | | - Bjørn Heine Strand
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Rianne de Gelder
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
| |
Collapse
|
135
|
van Baal P, Peters F, Mackenbach J, Nusselder W. Forecasting differences in life expectancy by education. Population Studies 2016; 70:201-16. [PMID: 27052447 DOI: 10.1080/00324728.2016.1159718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Forecasts of life expectancy (LE) have fuelled debates about the sustainability and dependability of pension and healthcare systems. Of relevance to these debates are inequalities in LE by education. In this paper, we present a method of forecasting LE for different educational groups within a population. As a basic framework we use the Li-Lee model that was developed to forecast mortality coherently for different groups. We adapted this model to distinguish between overall, sex-specific, and education-specific trends in mortality, and extrapolated these time trends in a flexible manner. We illustrate our method for the population aged 65 and over in the Netherlands, using several data sources and spanning different periods. The results suggest that LE is likely to increase for all educational groups, but that differences in LE between educational groups will widen. Sensitivity analyses illustrate the advantages of our proposed method.
Collapse
|
136
|
Torssander J, Ahlbom A, Modig K. Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes. PLoS One 2016; 11:e0152369. [PMID: 27031107 PMCID: PMC4816523 DOI: 10.1371/journal.pone.0152369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy. METHODS Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60). RESULTS The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals. CONCLUSIONS Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades.
Collapse
Affiliation(s)
- Jenny Torssander
- The Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
- * E-mail:
| | - Anders Ahlbom
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
137
|
Mackenbach JP, Martikainen P, Menvielle G, de Gelder R. The arithmetic of reducing relative and absolute inequalities in health: a theoretical analysis illustrated with European mortality data. J Epidemiol Community Health 2016; 70:730-6. [DOI: 10.1136/jech-2015-207018] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/18/2016] [Indexed: 12/22/2022]
|
138
|
McLaren L, McNeil DA, Potestio M, Patterson S, Thawer S, Faris P, Shi C, Shwart L. Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation. Int J Equity Health 2016; 15:24. [PMID: 26864565 PMCID: PMC4750250 DOI: 10.1186/s12939-016-0312-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. METHODS We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. RESULTS Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. CONCLUSIONS Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.
Collapse
Affiliation(s)
- Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Deborah A McNeil
- Research and Innovation, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada.
| | - Melissa Potestio
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Alberta Cancer Prevention Legacy Fund, Population Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada.
| | - Steve Patterson
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Salima Thawer
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Peter Faris
- Research Facilitation, Priorities, and Implementation, Alberta Health Services, Calgary, AB, Canada.
| | - Congshi Shi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Luke Shwart
- Provincial Oral Health Office, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
139
|
Brose LS, McEwen A. Neighbourhood Deprivation and Outcomes of Stop Smoking Support--An Observational Study. PLoS One 2016; 11:e0148194. [PMID: 26824352 PMCID: PMC4732751 DOI: 10.1371/journal.pone.0148194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Rates of smoking and smoking cessation vary with socio-economic status. The objectives were to assess the association between neighbourhood deprivation, completion of treatment to support quit attempts and success of quit attempts—while taking into account other predictors of outcome. Methods 555,744 quit attempts supported by English Stop Smoking Services in 2009–2012 were linked to the Index of Multiple Deprivation (IMD) 2010 ranks for the clients’ neighbourhood and split into deciles relative to the national IMD. Logistic regressions tested the association between neighbourhood deprivation and completion (4-week follow-up) of treatment and biochemically validated success (expired-air carbon monoxide <10ppm) while adjusting for demographics and intervention characteristics. Sensitivity analyses assessed subsamples: first supported attempts (n = 364,397), those with recorded cigarette dependence (n = 98,659) and completed treatment (n = 416,436). Results Higher neighbourhood deprivation was associated with reduced completion (ORadj = 0.949, 95% CI: 0.947 to 0.951) and success (ORadj = 0.957, 95% CI: 0.955 to 0.959). Results of sensitivity analyses were consistent with those of the main analysis. Conclusions Neighbourhood deprivation was associated with small but consistent reductions in completion and success of evidence-based interventions. These associations were not explained by intervention characteristics, demographics or dependence and reduced completion did not fully account for reduced success.
Collapse
Affiliation(s)
- Leonie S. Brose
- National Addiction Centre & UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Andy McEwen
- National Centre for Smoking Cessation and Training & Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| |
Collapse
|
140
|
Hu Y, van Lenthe FJ, Borsboom GJ, Looman CWN, Bopp M, Burström B, Dzúrová D, Ekholm O, Klumbiene J, Lahelma E, Leinsalu M, Regidor E, Santana P, de Gelder R, Mackenbach JP. Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. J Epidemiol Community Health 2016; 70:644-52. [PMID: 26787202 DOI: 10.1136/jech-2015-206780] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010. METHODS Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities. RESULTS We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities. CONCLUSIONS Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.
Collapse
Affiliation(s)
- Yannan Hu
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerard J Borsboom
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthias Bopp
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dagmar Dzúrová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jurate Klumbiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mall Leinsalu
- Stockholm Centre on Health of Societies in Transition, Södertörn University, Huddinge, Sweden Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
141
|
Abstract
Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.
Collapse
Affiliation(s)
| | - Christopher Jencks
- Kennedy School of Government, Harvard University, Cambridge, Massachusetts 02138; ,
| |
Collapse
|
142
|
Fedeli U, Avossa F, Goldoni CA, Caranci N, Zambon F, Saugo M. Education level and chronic liver disease by aetiology: A proportional mortality study. Dig Liver Dis 2015; 47:1082-5. [PMID: 26315625 DOI: 10.1016/j.dld.2015.07.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are lacking on mortality from chronic liver diseases of different aetiology by education level. AIMS To investigate the association between education level and mortality from alcoholic, viral, and non-viral/non-alcoholic chronic liver disease. METHODS Proportional mortality was investigated in 2011-2013 in the Veneto Region (Italy). Odds ratios were estimated by conditional logistic regression with deaths from liver cirrhosis, liver cancer, and viral hepatitis as cases, and all other deaths as controls. Disease aetiology was determined from all conditions mentioned in the death certificate. RESULTS Overall chronic liver disease proportional mortality was higher in males (OR 1.37, 95% CI 1.18-1.60) and females (OR 1.72, 95% CI 1.29-2.30) with primary education than in subjects with higher educational level. The risk for alcohol-related and non-viral/non-alcohol-related disease significantly increased with lower education in both genders. CONCLUSIONS Proportional mortality analysis of multiple causes of death records showed an association between education and chronic liver diseases with alcoholic and non-viral/non-alcoholic aetiology.
Collapse
Affiliation(s)
- Ugo Fedeli
- SER - Epidemiological Department, Veneto Region, Italy.
| | | | | | - Nicola Caranci
- Regional Health and Social Care Agency of Emilia-Romagna, Italy
| | - Francesco Zambon
- WHO European Office for Investment for Health and Development, Venice, Italy
| | - Mario Saugo
- SER - Epidemiological Department, Veneto Region, Italy
| |
Collapse
|
143
|
Regidor E, Reques L, Belza MJ, Kunst AE, Mackenbach JP, de la Fuente L. Education and mortality in Spain: a national study supports local findings. Int J Public Health 2015; 61:139-145. [PMID: 26572139 DOI: 10.1007/s00038-015-0762-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 10/29/2015] [Accepted: 11/04/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To estimate educational inequalities in mortality in Spain and in three Spanish areas: Madrid, Barcelona, and the Basque country. METHODS A national prospective study was carried out including all persons aged 25-74 years living in Spain in 2001 and followed up for mortality over 7 years. The mortality rate ratio and difference from all causes and from leading causes of death were estimated for the entire Spanish population and for the above three geographical areas. RESULTS With respect to people with the highest education, the mortality rate ratios in the entire population of Spain in people with the second highest, second lowest and lowest education were, respectively, 1.09, 1.10, 1.39 in women and 1.19, 1.27 and 1.54 in men. The mortality rate differences per 100,000 person-years were, respectively, 24.8, 28.3, 108.2 in women and 116.7, 162.5 and 319.1 in men. These estimates were intermediate in magnitude compared to those seen in the three geographical areas. CONCLUSIONS The results provide further evidence that educational inequalities in mortality are smaller in the south of Europe than in other European countries.
Collapse
Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Laura Reques
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - María J Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
144
|
Bann D, Hardy R, Cooper R, Lashen H, Keevil B, Wu FCW, Holly JMP, Ong KK, Ben-Shlomo Y, Kuh D. Socioeconomic conditions across life related to multiple measures of the endocrine system in older adults: Longitudinal findings from a British birth cohort study. Soc Sci Med 2015; 147:190-9. [PMID: 26588434 PMCID: PMC4686046 DOI: 10.1016/j.socscimed.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/08/2015] [Accepted: 11/01/2015] [Indexed: 12/29/2022]
Abstract
Background Little is known about how socioeconomic position (SEP) across life impacts on different axes of the endocrine system which are thought to underlie the ageing process and its adverse consequences. We examined how indicators of SEP across life related to multiple markers of the endocrine system in late midlife, and hypothesized that lower SEP across life would be associated with an adverse hormone profile across multiple axes. Methods Data were from a British cohort study of 875 men and 905 women followed since their birth in March 1946 with circulating free testosterone and insulin-like growth factor-I (IGF-I) measured at both 53 and 60–64 years, and evening cortisol at 60–64 years. Indicators of SEP were ascertained prospectively across life—paternal occupational class at 4, highest educational attainment at 26, household occupational class at 53, and household income at 60–64 years. Associations between SEP and hormones were investigated using multiple regression and logistic regression models. Results Lower SEP was associated with lower free testosterone among men, higher free testosterone among women, and lower IGF-I and higher evening cortisol in both sexes. For example, the mean standardised difference in IGF-I comparing the lowest with the highest educational attainment at 26 years (slope index of inequality) was −0.4 in men (95% CI -0.7 to −0.2) and −0.4 in women (−0.6 to −0.2). Associations with each hormone differed by SEP indicator used and sex, and were particularly pronounced when using a composite adverse hormone score. For example, the odds of having 1 additional adverse hormone concentration in the lowest compared with highest education level were 3.7 (95% CI: 2.1, 6.3) among men, and 1.6 (1.0, 2.7) among women (P (sex interaction) = 0.02). We found no evidence that SEP was related to apparent age-related declines in free testosterone or IGF-I. Conclusions Lower SEP was associated with an adverse hormone profile across multiple endocrine axes. SEP differences in endocrine function may partly underlie inequalities in health and function in later life, and may reflect variations in biological rates of ageing. Further studies are required to assess the likely functional relevance of these associations. Socioeconomic position (SEP) across life was related to multiple hormone measures. Lower SEP was related to lower testosterone in men, higher testosterone in women. Lower SEP was related to lower IGF-I and higher evening cortisol in both sexes. SEP differences in multiple hormone axes may underlie later life health inequality.
Collapse
Affiliation(s)
- David Bann
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK; Centre for Longitudinal Studies, UCL Institute of Education, London, UK.
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Hany Lashen
- Department of Human Metabolism, The University of Sheffield, Sheffield, UK
| | - Brian Keevil
- Andrology Research Unit, School of Biomedicine, University of Manchester, UK
| | - Frederick C W Wu
- Andrology Research Unit, School of Biomedicine, University of Manchester, UK
| | - Jeff M P Holly
- School of Clinical Science, Bristol University, Bristol, UK
| | - Ken K Ong
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| |
Collapse
|
145
|
Salmi LR, Barsanti S, Bourgueil Y, Daponte A, Piznal E, Ménival S, Ménival S, Piznal E, Salmi LR, Leleu H, Jusot F, Bourgueil Y, Saton MO, Piznal E, Kovacs Z, Novakovic A, Codina AD, Bolivar J, Mateo I, Pérez IR, Georgiou V, Janzyk V, Salfield N, Ismail Z, Giannoni M, D'Urzo E, Ferialla L, Barsanti S, Heijmans S, Pucci T, Di Loreto P, Cleanthous P, Salmi LR, Mouillet E, Barsanti S, Iacovina N, Nuti S, de Saint Pol E, Piznal E, Salfield N, Szabo Z, Kovacs Z, Novakovic A, Mratovic MC, Boban AD, Daponte A, Bolivar J, Mateo I, Pérez IR, Barnhoorn F, Berghmans L, Harlet J, Bourgueil Y, Bederski K, Theren G, Caleja N, Almeida M, Heijmans S, Marquez S, Carriazo A, Gonzalez-Seco I, Salmi LR, Hofmeister A, Cleanthous P, Daponte A, Bolivar J, Mateo I, Pérez IR, Solano MB, Marquez S, González-Seco I, de Saint Pol E, Piznal E, Godwin A, Mratovic MC, Mourtou E, Berghmans L, Bourgueil Y, Theren G, Hering T, Heijmans S, Barsanti S, Salmi LR, Ménival S, Piznal E, Mouillet E, Berghmans L, Harlet J, Bizel P, Pensis G, Szabo Z, Kovacs Z, Bourgueil Y, Jusot F, Leleu H, Barsanti S, Iacovina N, Daponte A, Bolivar J, Bernal Solano M, Mateo I, Ruis Pérez I, Salfield N, Godwin A, Rajaratnam G, Jobarteh J, Cleanthous P, Heijmans S, Novakovic A, Mratovic MC, Dzona-Boban A, Ismail Z, Giannoni M, D'Urzo E, Ferialla L, Cassucci P, Ammannati B, Tanini D, Bottai R, Berti A, Georgiou V, Hultgren E, Barnhoorn F, de Saint Pol E, Mc Shane M, Gonzalez-Seco I, Guérin D, Wardle M, Sandor J, Theren G, Hofmeister A, Carriazo A, Marquez S, Loizou C, Bederski K, Caleja N, Almeida M. Interventions addressing health inequalities in European regions: the AIR project. Health Promot Int 2015; 32:430-441. [DOI: 10.1093/heapro/dav101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux F-33000, France
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux F-33000, France
- CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux F-33000, France
| | - Sara Barsanti
- Scuola Superiore Sant'Anna di Pisa, Laboratorio Management e Sanità, Pisa, Italy
| | - Yann Bourgueil
- Institut de Recherche et de Documentation en Economie de la Santé, Paris, France
| | - Antonio Daponte
- Escuela Andaluza de Salud Pública, Granada, Andalucia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
146
|
Jasilionis D, Shkolnikov VM. Longevity and Education: A Demographic Perspective. Gerontology 2015; 62:253-62. [PMID: 26375385 DOI: 10.1159/000438901] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/22/2015] [Indexed: 11/19/2022] Open
Abstract
In the second half of the 20th century, the advances in human longevity observed have been accompanied by an increase in the disparities between countries and regions. Education is one of the strongest predictors of life expectancy. Studies have shown that both relative and absolute mortality differences by education within countries have been increasing, even in the most developed and egalitarian countries. It is possible to assume that groups of highly educated people who systematically display life expectancy levels which are higher than the observed best practice (record) life expectancy at the national level are vanguards who are leading the way toward a lengthening of life for the remaining population groups. This evidence based on population-level statistics and exploring an important single factor could inspire further discussion about the possibilities for extending human length of life at the national level. However, more comprehensive and reliable data covering a larger number of countries and more covariates are needed for understanding health effects of education and prospects of human longevity.
Collapse
|
147
|
Cacciani L, Bargagli AM, Cesaroni G, Forastiere F, Agabiti N, Davoli M. Education and Mortality in the Rome Longitudinal Study. PLoS One 2015; 10:e0137576. [PMID: 26376166 PMCID: PMC4572712 DOI: 10.1371/journal.pone.0137576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 01/25/2023] Open
Abstract
Background A large body of evidence supports an inverse association between socioeconomic status and mortality. We analysed data from a large cohort of residents in Rome followed-up between 2001 and 2012 to assess the relationship between individual education and mortality. We distinguished five causes of death and investigated the role of age, gender, and birthplace. Methods From the Municipal Register we enrolled residents of Rome on October 21st 2001 and collected information on educational level attained from the 2001 Census. We selected Italian citizens aged 30–74 years and followed-up their vital status until 2012 (n = 1,283,767), identifying the cause of death from the Regional Mortality Registry. We calculated hazard ratios (HRs) for overall and cause-specific mortality in relation to education. We used age, gender, and birthplace for adjusted or stratified analyses. We used the inverse probability weighting approach to account for right censoring due to emigration. Results We observed an inverse association between education (none vs. post-secondary+ level) and overall mortality (HRs(95%CIs): 2.1(1.98–2.17), males; 1.5(1.46–1.59), females) varying according to demographic characteristics. Cause-specific analysis also indicated an inverse association with education, in particular for respiratory, digestive or circulatory system related-mortality, and the youngest people seemed to be more vulnerable to low education. Conclusion Our results confirm the inverse association between education and overall or cause-specific mortality and show differentials particularly marked among young people compared to the elderly. The findings provide further evidence from the Mediterranean area, and may contribute to national and cross-country comparisons in Europe to understand the mechanisms generating socioeconomic differentials especially during the current recession period.
Collapse
Affiliation(s)
- Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | | | - Giulia Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| |
Collapse
|
148
|
Regidor E, Vallejo F, Reques L, Cea L, Miqueleiz E, Barrio G. Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation. Soc Sci Med 2015; 141:142-50. [DOI: 10.1016/j.socscimed.2015.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022]
|
149
|
Stringhini S, Spadea T, Stroscia M, Onorati R, Demaria M, Zengarini N, Costa G. Decreasing educational differences in mortality over 40 years: evidence from the Turin Longitudinal Study (Italy). J Epidemiol Community Health 2015; 69:1208-16. [PMID: 26186242 DOI: 10.1136/jech-2015-205673] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent studies suggest that inequalities in premature mortality have continued to rise over the last decade in most European countries, but not in southern European countries. METHODS In this study, we assess long-term trends (1971-2011) in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a record-linkage study including all individuals resident in Turin in the 1971, 1981, 1991 and 2001 censuses, and aged 30-99 years (more than 2 million people). We examined mortality for all causes, cardiovascular disease (CVD), all cancers and specific cancers (lung, breast), as well as smoking and alcohol-related mortality. RESULTS Overall mortality substantially decreased in all educational groups over the study period, although cancer rates only slightly declined. Absolute inequalities decreased for both genders (SII=962/694 in men/women in 1972-1976 and SII=531/259 in 2007-2011, p<0.01). Among men, absolute inequalities for CVD and alcohol-related causes declined (p<0.05), while remaining stable for other causes of death. Among women, declines in absolute inequalities were observed for CVD, smoking and alcohol-related causes and lung cancer (p<0.05). Relative inequalities in all-cause mortality remained stable for men and decreased for women (RII=1.92/2.03 in men/women in 1972-1976 and RII=2.15/1.32 in 2007-2011). Among men, relative inequalities increased for smoking-related causes, while among women they decreased for all cancers, CVD, smoking-related causes and lung cancer (p<0.05). CONCLUSIONS Absolute inequalities in mortality strongly declined over the study period in both genders. Relative educational inequalities in mortality were generally stable among men; while they tended to narrow among women. In general, this study supports the hypothesis that educational inequalities in mortality have decreased in southern European countries.
Collapse
Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Morena Stroscia
- Public Health and Paediatric Sciences Department, University of Turin, Turin, Italy
| | - Roberta Onorati
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Moreno Demaria
- Department of Epidemiology and Environmental Health, Regional Environment Protection Agency, Grugliasco (TO), Italy
| | - Nicolás Zengarini
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| |
Collapse
|
150
|
Kröger H, Pakpahan E, Hoffmann R. What causes health inequality? A systematic review on the relative importance of social causation and health selection. Eur J Public Health 2015; 25:951-60. [PMID: 26089181 DOI: 10.1093/eurpub/ckv111] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The social gradient in health is one of the most reliable findings in public health research. The two competing hypotheses that try to explain this gradient are known as the social causation and the health selection hypothesis. There is currently no synthesis of the results of studies that test both hypotheses. METHODS We provide a systematic review of the literature that has addressed both the health selection and social causation hypotheses between 1994 and 2013 using seven databases following PRISMA rules. RESULTS The search strategy resulted in 2952 studies, of which, we included 34 in the review. The synthesis of these studies suggests that there is no general preference for either of the hypotheses (12 studies for social causation, 10 for health selection). However, both a narrative synthesis as well as meta-regression results show that studies using indicators for socio-economic status (SES) that are closely related to the labor market find equal support for health selection and social causation, whereas indicators of SES like education and income yield results that are in favor of the social causation hypothesis. High standards in statistical modeling were associated with more support for health selection. CONCLUSIONS The review highlights the fact that the causal mechanisms behind health inequalities are dependent on whether or not the dimension being analyzed closely reflects labor market success. Additionally, further research should strive to improve the statistical modeling of causality, as this might influence the conclusions drawn regarding the relative importance of health selection and social causation.
Collapse
Affiliation(s)
- Hannes Kröger
- Department of Political and Social Sciences, European University Institute, Via dei Roccettini, 9, 50014 San Domenico di Fiesole, Italy
| | - Eduwin Pakpahan
- Department of Political and Social Sciences, European University Institute, Via dei Roccettini, 9, 50014 San Domenico di Fiesole, Italy
| | - Rasmus Hoffmann
- Department of Political and Social Sciences, European University Institute, Via dei Roccettini, 9, 50014 San Domenico di Fiesole, Italy
| |
Collapse
|