Changes in mortality inequalities over two decades: register based study of European countries

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.

Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste

“…Kanskje overraskende er helseforskjellene i Norge og Norden blant de største i Europa (Mackenbach, Kulhanova, Artnik, Bopp mfl., 2016). Dette omtales ofte som et paradoks, da både Norge og Norden har velutviklede velferdssystemer og relativt lav ulikhet i inntekt og levekår sammenlignet med de andre europeiske landene, noe man kunne forvente skulle føre til mindre helseforskjeller (Dahl mfl., 2014).…”

Att minska ojämlikhet i hälsa – några dilemman

“…Förklaringen kan främst vara matematisk. Vid minskad dödlighet ökar vanligen de relativa skillnaderna medan de absoluta skillnaderna minskar (T. Eikemo, Skalicka, & Avendano, 2009;Mackenbach et al, 2016). Detta skulle kunna vara en av förklaringarna till utvecklingen i de nordiska länderna.…”

Norwegian support for tackling health inequalities in Lithuania: the process, pitfalls and results

“…European studies have clearly demonstrated a downward trend in all-cause mortality among both low-and high-educated persons in many European countries, with the exception of Lithuania, where mortality increased among the low-educated [3].…”