Income-related health inequalities in France in 2004: Decomposition and explanations

Abstract

Background This analysis supplements existing work on social health inequalities at two levels: the measurement of health and the measurement of inequalities. Firstly, individual health status was measured using a subjective health indicator corrected within a promising cardinalisation method which had not yet been carried out on French data. Secondly, this study used an innovative methodology to measure income-related health inequalities, to understand the relationships between income, income inequality, various social determinants, and health. Methods The analysis was based on a sample of working-age adults from the 2004 Health and Health Insurance Survey. The methodology used in the study measures the total income-related health inequality using the concentration index. This index is based on a linear model explaining health according to several individual characteristics, such as age, sex, and various socioeconomic characteristics. The method thus takes into account both the causal relationships between the various explicative factors introduced in the model and their relationship with health. Furthermore, it concretely measures the contribution of the social determinants to income-related health inequalities. Results The results show an income-related health inequality favouring individuals with a higher income. Moreover, income level, supplementary private health insurance, education level, and social class account for the main contributions to inequality. Therefore, the decomposition method highlights population groups that policies should target. Conclusion The study suggests that reducing income inequality is not sufficient to lower income-related health inequalities in France in 2004 and needs to be supplemented with the reduction of the relationship between income and health and the reduction of income inequality over socioeconomic status.