Educational Inequalities in Life and Healthy Life Expectancies among the 50-Plus in Spain.

Unai Martín,Antía Domínguez Rodríguez,Aïda Solé-Auró

doi:10.3390/ijerph17103558

Abstract

This study computes educational inequalities in life expectancy (LE), healthy life expectancy (HLE), and unhealthy life expectancy (ULE) by gender and education level in Spain in 2012. Death registrations and vital status by level of education were obtained from Spain’s National Institute of Statistics. Health prevalences were estimated from the National Health Survey for Spain. We used Sullivan’s method to compute HLE, ULE, and the proportion of time lived with health problems. Our results reveal that Spanish women live longer than men in all education groups, but a higher proportion of women report poor health. We detect substantial differences in unhealthy life by gender and education, with higher effect for women and for those with low levels of education. Poor self-perceived health shows the largest educational gradient; chronic diseases present the lowest. This is the first work that provides evidence on health inequalities by education level in Spain. Our findings seem to be in line with reports of the smaller social inequalities experienced in Southern Europe and highlight the importance of education level on extending the proportion of years spent in good health in a Mediterranean country.

Highlights

Great advances in life expectancy (LE) have been recorded in most high-income countries over the last century, reflecting improvements in medical technology, better socioeconomic conditions, and healthier lifestyles
Our study describes notable inequalities both in the duration of life and in the quality of life of Spain’s older generation
Our study provides new evidence of a possibly lower gradient in mortality and health in a Southern European country with higher levels of social inequality and a limited social protection system

Summary

Introduction

Great advances in life expectancy (LE) have been recorded in most high-income countries over the last century, reflecting improvements in medical technology, better socioeconomic conditions, and healthier lifestyles. The fact that these advances are not necessarily accompanied by improvements in the population’s health has generated considerable debate. In addition to monitoring progress in the health of individuals, scholars have sought to determine if increasing longevity is associated with sustained country differences in health, at older ages [1]. Scholars stress the need to monitor gender and educational inequalities in longevity within populations, since understanding the associated mechanisms could help reduce inequalities between groups and improve a population’s overall health. In Spain, any understanding of the social inequalities associated with healthy life expectancy (HLE) is scant. Recent studies have examined inequalities in LE [2,3], but only a few have analyzed

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