Trends In Mortality Inequalities Research Articles

Mortality inequality in Chile

AbstractThis paper analyses trends in mortality inequality in 330 Chilean communes from 1990 to 2010 for different age groups and both genders. Chile had substantial inequalities in local‐level mortality rates in 1990 but by 2010 these disparities had significantly decreased, especially among infants, children and the elderly. The only exception was Chilean men aged 20–39, for whom inequality in mortality remained persistently high. Robust economic growth and targeted health interventions in the 1990s contributed to declining mortality rates and mortality inequality. From 2000 to 2010, efforts to expand safety nets and improve health‐care access continued, with a greater impact on adults aged 49 years and above. Despite these advances, child mortality remains significantly higher than in developed countries, and the increasing number of female suicides in younger age groups represents a concerning trend.

Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study.

SummaryBackgroundDisparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England.MethodsVital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10% of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose.FindingsAmong <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the richest 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period – from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution – between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA.InterpretationOverall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups.FundingEconomic and Social Research Council, through the ESRC Centre for the Microeconomic Analysis of Public Policy at the IFS. We gratefully acknowledge the support of the Nuffield Foundation, grant reference WEL/43603. The project has been funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre.

Trends in mortality inequalities among the adult household population.

The routine measurement of population health status indicators like mortality is important to assess progress in the reduction of inequalities. Previous studies of mortality inequalities have relied on area-based measures of socioeconomic indicators. A new series of census-mortality linked datasets has been created in Canada to quantify mortality inequalities based on individual-level data and examine whether these inequalities have changed over time. This study used the 1991, 1996, 2001, 2006, and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) with five years of mortality follow-up. It estimated age-standardized mortality rates by sex according to income quintile and highest level of educational attainment categories for the household population aged 25 or older. Absolute and relative measures of mortality inequality were also estimated. Men had a greater reduction in mortality rates over time compared with women, regardless of income or education level. Absolute income-related mortality inequality decreased for men but increased for women over time, while relative income-related inequality increased for both sexes. Education-related mortality inequality for women followed the same pattern as income, though the absolute mortality difference for men remained roughly unchanged over the period. Mortality inequalities by income and education persist in Canada, and have increased for women. Further research to determine the mechanisms underlying these trends could help address the complex challenge of reducing health inequalities in Canada.

Trends in mortality inequalities in an urban area: the influence of immigration

BackgroundNearly 20% of the population in Barcelona is foreign-born and this percentage rises to up to 40% in some neighborhoods. Consequently, migration health patterns may play an important role in trends in socioeconomic geographical inequalities in mortality. The objective of this study was to analyze the trend in socioeconomic inequalities in mortality between neighborhoods in Barcelona during the period 2001–2012 in the foreign-born and Spanish-born population.MethodsRepeated cross-sectional design of the population aged 25–64 years in Barcelona between 2001 and 2012. Hierarchical data consisted of yearly mortality linked-population. The variables analyzed were age, sex, education, and country of birth (Spanish-born, foreign-born), neighborhood of residence, and the socioeconomic level of the neighborhoods using quartiles of unemployment rates. Age-standardized mortality rates were estimated, and mixed Poisson regressions were applied using generalized linear mixed models, including two random effects to consider the intracorrelation within neighborhoods and across years.ResultsThe number of foreign-born residents aged 25–64 increased notably in disadvantaged neighborhoods. Approximately 9% of premature deaths occurred in foreign-born individuals. Premature mortality rates were higher in disadvantaged neighborhoods and in the Spanish-born population in all periods. Despite the stabilized socioeconomic inequalities in mortality in the Spanish-born population, no inequalities were found between neighborhoods in foreign-born men and women.ConclusionsEvidence of the ‘healthy migrant’ effect in mortality and socioeconomic inequalities in mortality was found in Barcelona, which seems to alter the distribution of mortality through time and space, related to the low levels of premature mortality and the selective residence of immigrants in socioeconomically disadvantaged neighborhoods.

How do trends in mortality inequalities by deprivation and education in Scotland and England & Wales compare? A repeat cross-sectional study

ObjectiveTo compare the trends in mortality inequalities by educational attainment with trends using area deprivation.SettingScotland and England & Wales (E&W).ParticipantsAll people resident in Scotland and E&W between 1981 and 2011...

The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.

BackgroundOver the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities.MethodsWe collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35–79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality.ResultsThe general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance.ConclusionsWe find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0390-0) contains supplementary material, which is available to authorized users.

Mortality Inequality: The Good News from a County-Level Approach

Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today's children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population. We show that the differential timing of smoking reductions among the rich and the poor can explain a significant fraction of the current increase in mortality inequality in older cohorts.

How robust is the calculation of health inequality trends by educational attainment in England and Wales using the Longitudinal Study?

Background and objectivesInequalities in mortality by educational attainment are wider in Eastern Europe than in West and Central Europe, but have thus far been largely limited to cross-sectional analyses. This study explored the potential to use the Longitudinal Study to describe trends in mortality inequality by educational attainment in England and Wales from 1971 to 2009 and the limitations in the available data. Study designComparison of cohort studies. MethodsData from the Office for National Statistics Longitudinal Study were used which takes a sample of respondees from each Census (1971–2001) and links them to death certification. Age-standardized mortality was calculated by educational attainment for those aged 25–69 years as was the Relative Index of Inequality and Slope Index of Inequality for men and women for each time period. ResultsOverall mortality declined in all categories of educational attainment for men and women from 1971. Limited data were collected on educational attainment in the Censuses prior to 2001, combined with the high proportion of respondents with missing data or reporting ‘no education’, meant that estimates of inequalities for the period 1971 to 2000 were very imprecise and likely to be misleading. For 2001–2009, the slope index of inequality was 268 (95% CI 57–478) and relative index of inequality was 0.61 (95% CI 0.13–1.10) for the total population; 354 (95% CI 72–636) and 0.67 (95% CI 0.14–1.21) respectively for men; and 231 (95% CI 72–389) and 0.66 (95% CI 0.21–1.11) respectively for women. ConclusionsLimited educational data in the Censuses prior to 2001 makes calculation of mortality inequalities by educational attainment in England and Wales imprecise and potentially misleading. International comparisons and time trend analyses using these data prior to 2001 should be done with great caution.

Mortality inequalities: Scotland versus England and Wales

This paper is an observational study of particular historical trends in mortality inequality within Great Britain, comparing England and Wales with Scotland for the period 1925–2005. The inequalities in mortality within Great Britain have become more apparent over time. Growing inequality in premature mortality in Britain affected young Scottish men most severely after 1995. It would appear that something dramatic happened to the Scottish population in early 1970s which accelerated these broad and very important mortality differentials within Great Britain. The divergence in mortality within Great Britain is notable in successive male cohorts and to a lesser extent in women.

Trends in educational inequalities in old age mortality in Norway 1961−2009: a prospective register based population study

BackgroundThe vast majority of deaths occur in older adults. Paradoxically, knowledge on long-term trends in mortality inequalities among the aged, and particularly for those aged 80 years and over, is sparse. The historical trends in size and impact of socioeconomic inequalities on old age mortality are important to monitor because they may give an indication on future burden of inequalities. We investigated trends in absolute and relative educational inequalities in old age mortality in Norway between 1961 and 2009.MethodsWe did a register-based population study covering the entire Norwegian population aged 65-94 in the years 1961−2009 (1,534,513 deaths and 29,312,351 person years at risk). By examining 1-year mortality rates by gender, age and educational level we estimated trends in mortality rate ratios and rate differences.ResultsOn average, age-standardised absolute inequalities increased by 0.17 deaths per 1000 person-years per year in men (P<0.001), and declined by 0.07 deaths per 1000 person-years per year in women (P<0.001). Trends in rate differences were largest in men aged 75−84 years, but differed in direction by age group in women. The corresponding mean increase in age-standardised relative inequalities was 0.4% and 0.1% per year in men and women, respectively (P<0.001). Trends in rate ratios were largest in the youngest age groups for both genders and negligible among women aged 85−94 years.ConclusionsWhile relative educational inequalities in old age mortality increased for both genders, absolute educational inequalities increased only temporarily in men and changed little among women. Our study show the importance of including absolute measures in inequality research in order to present a more complete picture of the burden of inequalities to policy makers. As even in older ages, inequalities represent an unexploited potential to public health, old age inequalities will become increasingly important as many countries are facing aging populations.

Unequal Geographic Distribution of Life Expectancy in Seoul

This study examined life expectancies in 25 gus, administrative districts of Seoul, the capital of Korea, by gender in 1995, 2002, and 2008 to explore trends in mortality inequality among areas. The authors constructed single-decrement life tables and employed between-group variance, the Theil index, and mean log deviation to measure absolute and relative disparities in life expectancy among areas during the periods 1995-2002 and 2002-2008. It was found that life expectancy gaps between gus have widened in absolute and relative terms in both genders over the decade, and that this pattern was particularly dramatic in females after 2002. This increasing gap could be attributable to the more negative health impact on females since the late 1990s stemming from the economic crisis, eventually reflected in their places of residence. Thus, a social buffer system to narrow the health gap between geographic areas and social classes must be established.

Intensifying Infant Mortality Inequality in India and a Reversal by Policy Intervention

The adverse sex ratio, a feature of India, is an outcome of two forms of inequality; natal inequality through sex‐selective abortion, and mortality inequality. The analysis of trends in mortality inequality at the infant stage, which is the subject of this paper, in the rural and urban areas of 15 major Indian states reveals that overall mortality inequality has intensified. This is particularly the case in the developed states, accounting for a large proportion of the foregone reduction in the infant mortality rate. However, the trend in Tamil Nadu state points to a reversal in mortality inequality in recent years on account of multi‐pronged policy interventions by the state government, which are aimed at protecting the girl child. The political‐will of the party in power during 1991–1996 and 2001–2006 in Tamil Nadu points the way for the rest of the nation, and is possibly the way for India to achieve the Millennium Development Goal with respect to the infant mortality rate.

Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century

Objective:To analyse trends in mortality inequalities by educational level for main causes of death among men and women in Barcelona, Spain, at the turn of the 21st century (1992–2003).Methods:The population...

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining...