Abstract
BackgroundSubstantial research has documented variations in the magnitude of relative socioeconomic differences in health across European countries, and within countries, across different age groups. The aim of this paper is to examine to what extent these variations are determined by differences in the overall rate or prevalence of a health outcome across countries and age-groups in the total population.MethodsThree surveys (European Social Survey, and two different population census-mortality registry linked longitudinal data) were used. We plotted rates of mortality and prevalence of poor self-rated health against ratios of mortality and morbidity prevalence associated with educational level. We calculated Pearson coefficients to examine the magnitude of correlations.ResultsWe found a significant negative correlation between total mortality rates and associated rate ratios of mortality by education in the SEDHA study (r = -0.40, p = 0.04), but not in the HUNT study (r = -0.37, p = 0.06). There was a weaker but significant negative correlation between the prevalence of poor health and associated prevalence ratios by education in the European social survey (r = -0.22, p = 0.00). Correlations increased as underlying prevalence and rates increased, while they were weaker or null at low prevalence or rates.ConclusionWe found some evidence that the magnitude of relative inequalities in mortality and morbidity is negatively correlated with underlying morbidity prevalence and mortality rates. Although correlations are moderate, underlying morbidity prevalence and mortality rates should be taken into account in the interpretation of variations in relative health inequalities among populations.
Highlights
It has been pointed out that variations in health inequalities can be explained by a mathematical rule rather than by substantial interpretations. [1] This heuristic mathematical rule (HRX) suggests that all measures of differences between rates of experiencing binary outcomes, as well as all measures that are functions of binary outcomes, appear to change in one manner or another as thereInternational Journal for Equity in Health 2009, 8:32 http://www.equityhealthj.com/content/8/1/32 occurs a change in the overall prevalence of an outcome
We found some evidence that the magnitude of relative inequalities in mortality and morbidity is negatively correlated with underlying morbidity prevalence and mortality rates
Correlations are moderate, underlying morbidity prevalence and mortality rates should be taken into account in the interpretation of variations in relative health inequalities among populations
Summary
It has been pointed out that variations in health inequalities can be explained by a mathematical rule rather than by substantial interpretations. [1] This heuristic mathematical rule (HRX) suggests that all measures of differences between rates of experiencing binary outcomes, as well as all measures that are functions of binary outcomes, appear to change in one manner or another as there (page number not for citation purposes)International Journal for Equity in Health 2009, 8:32 http://www.equityhealthj.com/content/8/1/32 occurs a change in the overall prevalence of an outcome. It has been shown that rate ratios of health vary by country, and by age, gender, or many other demographic characteristics. It is known, that as death rates increase, the relative risk becomes smaller, and as death rates decrease, they become larger. Rate ratios of inequalities for two diseases that have the same level of inequality but one of them is twice as common that the other one will yield different rate ratios In such cases, we need to carefully interpret variations in estimates of relative health inequalities. The aim of this paper is to examine to what extent these variations are determined by differences in the overall rate or prevalence of a health outcome across countries and age-groups in the total population
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