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.
Highlights
Inequalities in mortality and morbidity between people with a higher and lower socioeconomic position, as indicated by educational level, occupational class, or income level, are a persistent challenge for health policy
The results of regression analyses of the contribution of behavioral risk factors and poverty to between-country variations in inequalities in mortality are reported in Table 1a and Web Appendix Table A2
When we control for all four behavioral risk factors, the Rate Ratio for all-cause mortality declines from 1.89 to 1.44 (95%Confidence Interval (CI): 1.25–1.67), an attenuation of 62% (100 * (1.89-1.44)/(1.89-1.00))
Summary
Inequalities in mortality and morbidity between people with a higher and lower socioeconomic position, as indicated by educational level, occupational class, or income level, are a persistent challenge for health policy These inequalities are present within all European countries with available data, as shown in a series of comparative studies funded by the European Commission (Mackenbach et al, 2008). This geographical pattern applies to absolute inequalities in mortality (Web Appendix Fig. A1), because the mortality rates of the higher educated are rather similar between countries, whereas the mortality rates of the lower educated are much higher in some countries than in others (Lundberg et al.; van Raalte et al, 2011). The study reported in this paper aims to explore which factors might be involved in generating the between-country variations in inequalities in mortality and mortality trends illustrated above, by assessing, within the framework of an ecological analysis, the possible role of a number of behavioral as well as structural determinants
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