Determinants of inequalities in life expectancy: an international comparative study of eight risk factors

Abstract

Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. MethodsWe did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions.Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2•3-8•2 years among men and 0•6-4•5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19•8% among men and 18•9% among women), low income (9•7% and 13•4%), and high bodyweight (7•7% and 11•7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor.Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.

Sex differences in health and mortality by income and income changes

“…Similar to previous studies on income–health associations (eg, ref 8–10 30) we found that SES is a powerful determinant of health and that being disadvantaged during a period in mid-life has a significant impact on health and mortality particularly for men. Social mobility theories hypothesise that SES mobility across the life course impacts adult health.…”

“…Socioeconomic status (SES) is an important determinant of health,8 and differences in morbidity and mortality between SES groups are one of the most consistent epidemiological findings 9 10. In many populations, people with higher measures of SES such as income,11 12 education13 14 and occupational class15 16 are more likely to have longer life expectancy and reduced morbidity.…”

Changing effect of the numerator–denominator bias in unlinked data on mortality differentials by education: evidence from Estonia, 2000–2015

“…Monitoring socioeconomic inequalities in mortality is a crucial component for designing appropriate policies promoting more sustainable health development. 1 2 However, producing reliable evidence about the magnitude and changes in mortality inequalities requires precise register-based or census-linked data. Such data covering entire populations are still missing for many developed countries.…”

Social and Economic Determinants and Potential for Growth in Life Expectancy of the Population in the Russian Federation Taking Into Account Regional Differentiation

“…Неравенство в уровне образования, доходов и профессиональном положении отражается на разнице в показателях заболеваемости и смертности различных по данным показателям групп населения [23,24]. К примеру, образование человека является важной составляющей, от которой в будущем будет зависеть уровень получаемых им доходов.…”

“…Полученные данные в полной мере согласуются с результатами других исследований в данной области. Так, было установлено, что увеличение доли людей с высшим уровнем образования увеличивает ОПЖ, что, вероятно, связано с возможностью получения более полной информации о потенциальных рисках здоровью при более высоком уровне образования [24][25][26][27][28][29]. Кроме того, высшее образование часто сопряжено с более квалифицированной, престижной и оплачиваемой работой, что повышает качество жизни граждан.…”