Trends in health inequalities in 27 European countries

Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008...

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Published in:	Proceedings of the National Academy of Sciences - PNAS Vol. 115; no. 25; p. 6440
Main Authors:	Mackenbach, Johan P, Valverde, José Rubio, Artnik, Barbara, Bopp, Matthias, Brønnum-Hansen, Henrik, Deboosere, Patrick, Kalediene, Ramune, Kovács, Katalin, Leinsalu, Mall, Martikainen, Pekka, Menvielle, Gwenn, Regidor, Enrique, Rychtaříková, Jitka, Rodriguez-Sanz, Maica, Vineis, Paolo, White, Chris, Wojtyniak, Bogdan, Hu, Yannan, Nusselder, Wilma J
Format:	Journal Article
Language:	English
Published:	United States 19.06.2018
Subjects:	Adult Aged Economic Recession - statistics & numerical data Europe Female Health Status Disparities Healthcare Disparities - economics Healthcare Disparities - statistics & numerical data Humans Interrupted Time Series Analysis - statistics & numerical data Male Middle Aged Self Report Self-Assessment Socioeconomic Factors mortality health inequalities financial crisis morbidity Europe
ISSN:	1091-6490, 1091-6490
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Abstract	Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from 1980 to 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from 2002 to 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.
AbstractList	Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from 1980 to 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from 2002 to 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities. Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.
Author	Kovács, Katalin Menvielle, Gwenn Nusselder, Wilma J Vineis, Paolo Hu, Yannan Bopp, Matthias Martikainen, Pekka Artnik, Barbara Kalediene, Ramune Brønnum-Hansen, Henrik Deboosere, Patrick Mackenbach, Johan P Regidor, Enrique White, Chris Leinsalu, Mall Rychtaříková, Jitka Rodriguez-Sanz, Maica Wojtyniak, Bogdan Valverde, José Rubio
Author_xml	– sequence: 1 givenname: Johan P surname: Mackenbach fullname: Mackenbach, Johan P email: j.mackenbach@erasmusmc.nl organization: Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands; j.mackenbach@erasmusmc.nl – sequence: 2 givenname: José Rubio surname: Valverde fullname: Valverde, José Rubio organization: Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands – sequence: 3 givenname: Barbara surname: Artnik fullname: Artnik, Barbara organization: Department of Public Health, Faculty of Medicine, 1000 Ljubljana, Slovenia – sequence: 4 givenname: Matthias surname: Bopp fullname: Bopp, Matthias organization: Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8006 Zurich, Switzerland – sequence: 5 givenname: Henrik surname: Brønnum-Hansen fullname: Brønnum-Hansen, Henrik organization: Institute of Public Health, Copenhagen University, 1165 Copenhagen, Denmark – sequence: 6 givenname: Patrick surname: Deboosere fullname: Deboosere, Patrick organization: Department of Sociology, Vrije Universiteit Brussel, 1050 Ixelles, Belgium – sequence: 7 givenname: Ramune surname: Kalediene fullname: Kalediene, Ramune organization: Lithuanian University of Health Sciences, Kaunas 44307, Lithuania – sequence: 8 givenname: Katalin surname: Kovács fullname: Kovács, Katalin organization: Demographic Research Institute, 1525 Budapest, Hungary – sequence: 9 givenname: Mall surname: Leinsalu fullname: Leinsalu, Mall organization: Department of Epidemiology and Biostatistics, National Institute for Health Development, 11619 Tallinn, Estonia – sequence: 10 givenname: Pekka surname: Martikainen fullname: Martikainen, Pekka organization: Department of Sociology, University of Helsinki, 00100 Helsinki, Finland – sequence: 11 givenname: Gwenn surname: Menvielle fullname: Menvielle, Gwenn organization: INSERM, Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), 75646 Paris, France – sequence: 12 givenname: Enrique surname: Regidor fullname: Regidor, Enrique organization: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, 28040 Madrid, Spain – sequence: 13 givenname: Jitka surname: Rychtaříková fullname: Rychtaříková, Jitka organization: Department of Demography, Charles University, 128 43 Prague 2, Czech Republic – sequence: 14 givenname: Maica surname: Rodriguez-Sanz fullname: Rodriguez-Sanz, Maica organization: Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain – sequence: 15 givenname: Paolo surname: Vineis fullname: Vineis, Paolo organization: Medical Research Council-Public Health England Centre for Environment and Health, School of Public Health, Imperial College, London W2 1PG, United Kingdom – sequence: 16 givenname: Chris surname: White fullname: White, Chris organization: Office of National Statistics, Newport NP10 8XG, United Kingdom – sequence: 17 givenname: Bogdan surname: Wojtyniak fullname: Wojtyniak, Bogdan organization: Department of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, 00-791 Warsaw, Poland – sequence: 18 givenname: Yannan surname: Hu fullname: Hu, Yannan organization: Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands – sequence: 19 givenname: Wilma J surname: Nusselder fullname: Nusselder, Wilma J organization: Department of Public Health, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
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SubjectTerms	Adult Aged Economic Recession - statistics & numerical data Europe Female Health Status Disparities Healthcare Disparities - economics Healthcare Disparities - statistics & numerical data Humans Interrupted Time Series Analysis - statistics & numerical data Male Middle Aged Self Report Self-Assessment Socioeconomic Factors
Title	Trends in health inequalities in 27 European countries
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