Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowi...

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Autores: Mackenbach, JP, Valverde, JR, Bopp, M, Bronnum-Hansen, H, Costa, G, Deboosere, P, Kalediene, R, Kovacs, K, Leinsalu, M, Martikainen, P, Menvielle, G, Rodriguez-Sanz, M, Nusselder, WJ
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p13719
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=13719
Access Level:acceso abierto
Palabra clave:Mortality
Social inequality
Trends
Europe
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spelling Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015Mackenbach, JPValverde, JRBopp, MBronnum-Hansen, HCosta, GDeboosere, PKalediene, RKovacs, KLeinsalu, MMartikainen, PMenvielle, GRodriguez-Sanz, MNusselder, WJMortalitySocial inequalityTrendsEuropeSocioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.SPRINGER2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=13719EUROPEAN JOURNAL OF EPIDEMIOLOGYISSN: 03932990ISSNe: 15737284reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p137192026-06-14T12:41:47Z
dc.title.none.fl_str_mv Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
title Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
spellingShingle Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
Mackenbach, JP
Mortality
Social inequality
Trends
Europe
title_short Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
title_full Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
title_fullStr Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
title_full_unstemmed Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
title_sort Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
dc.creator.none.fl_str_mv Mackenbach, JP
Valverde, JR
Bopp, M
Bronnum-Hansen, H
Costa, G
Deboosere, P
Kalediene, R
Kovacs, K
Leinsalu, M
Martikainen, P
Menvielle, G
Rodriguez-Sanz, M
Nusselder, WJ
author Mackenbach, JP
author_facet Mackenbach, JP
Valverde, JR
Bopp, M
Bronnum-Hansen, H
Costa, G
Deboosere, P
Kalediene, R
Kovacs, K
Leinsalu, M
Martikainen, P
Menvielle, G
Rodriguez-Sanz, M
Nusselder, WJ
author_role author
author2 Valverde, JR
Bopp, M
Bronnum-Hansen, H
Costa, G
Deboosere, P
Kalediene, R
Kovacs, K
Leinsalu, M
Martikainen, P
Menvielle, G
Rodriguez-Sanz, M
Nusselder, WJ
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Mortality
Social inequality
Trends
Europe
topic Mortality
Social inequality
Trends
Europe
description Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=13719
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=13719
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER
publisher.none.fl_str_mv SPRINGER
dc.source.none.fl_str_mv EUROPEAN JOURNAL OF EPIDEMIOLOGY
ISSN: 03932990
ISSNe: 15737284
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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