The contribution of health policy and care to income differences in life expectancy – a register based cohort study

Abstract

BackgroundGrowing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland.MethodsThe study data were based on an 11% random sample of Finnish residents in 1988–2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group.ResultsOverall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences.ConclusionsThe results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

“…This development accelerated after 2004 due to the reduction in excise tax on alcohol [ 45 ]. Our observations support the interpretation that the increased use of alcohol in the lowest income quintile accounts for a significant proportion of Finland’s increasing socioeconomic inequalities in mortality [ 38 , 46 ].…”

Multiple social disadvantage does it have an effect on amenable mortality: a brief report

“…A recent study on all-cause mortality has reported increasing income group differences in life expectancy at age 35 [ 36 ]. Further, a study examining amenable mortality in addition to other causes found that in 2006–07 amenable mortality accounted for 9% of differences in life-expectancy between the highest and lowest income deciles among men and 17% among women [ 37 ]. Ischaemic heart disease mortality accounted for a fifth of the differences in life expectancy among both genders.…”

Reducing health inequalities in Finland: progressing or regressing?

“…) In a recent study of the trends in both relative and absolute inequalities in mortality in Europe between 1990 and 2010, Johan Mackenbach et al (2016) found that while relative inequalities in mortality had mostly grown everywhere, absolute inequalities had in fact decreased in most European countries, except in Finland and Norway. The stagnation and even decline of life expectancy in the lowest income group in Finland has also been shown by calculating the contribution of amenable causes of death to the increase in differences in life expectancy by income deciles (Manderbacka et al, 2013). Alcoholrelated mortality was the single most important contributor to the increase of differences 1.…”