Socioeconomic inequalities in health in 22 European countries.

Full Abstract

BACKGROUND:
Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.

METHODS:
We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.

RESULTS:
In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern.

CONCLUSIONS:
We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.Copyright 2008 Massachusetts Medical Society.

Learn Faster Today Improve your study skills

Author information

Author/s: Mackenbach, Johan P (JP); Stirbu, Irina (I); Roskam, Albert-Jan R (AJ); Schaap, Maartje M (MM); Menvielle, Gwenn (G); Leinsalu, Mall (M); Kunst, Anton E (AE); European Union Working Group on Socioeconomic Inequalities in Health;

Affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. j.mackenbach(-atsign-)erasmusmc.nl

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: The New England journal of medicine (N Engl J Med), published in United States. (Language: eng)

Reference: 2008-Jun; vol 358 (issue 23) : pp 2468-81

Dates: Created 2008/06/05; Completed 2008/06/19; Revised 2008/09/24;

PMID: 18525043, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: N Engl J Med. 2008 Jun 5;358(23):2509-10. (PMID: 18525049)

CommentIn: N Engl J Med. 2008 Sep 18;359(12):1290; author reply 1290-1. (PMID: 18799564)

ErratumIn: N Engl J Med. 2008 Sep 18;359(12):e14.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Age Factors
Aged
Alcoholism - mortality
Cause of Death
Educational Status
Europe - epidemiology
Female
Health Status Disparities
Healthcare Disparities - economics
Humans
Income

Income
Male
Middle Aged
Morbidity
Mortality
Obesity - mortality
Poisson Distribution
Regression Analysis
Sex Factors
Smoking - mortality
Social Class
Socioeconomic Factors

These are the highest related articles currently in the database:

See 100+ related articles.