The association between socioeconomic deprivation and old-age survival in five European countries–A cross-national ecological analysis

Abstract

Introduction Geographical differences in the spatial distribution of old-age survival exist in Europe and might be attributed to socioeconomic deprivation. In this study, we aimed to estimate the association between socioeconomic deprivation and old-age survival in Europe and investigate whether it varies by country and gender. Methods Our study incorporated five countries (Portugal, Spain, France, Italy, and England) and a total of 1911 small areas. A ten-year survival rate expressing the proportion of population aged 75–84 years who reached 85–94 years old was calculated at area-level for 2001–11. To estimate associations, we used Bayesian spatial models and a transnational measure of socioeconomic deprivation. Additionally, attributable/prevention fractions were calculated. Results Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a clear dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were weaker/absent. We projected that the elimination of socioeconomic differences between areas would increase survival by 7.1% and even a slight reduction in socioeconomic differences would mean a 1.6% higher survival in these countries. Conclusions Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.