Determinants of inequalities in life expectancy: an international comparative study of eight risk factors

Johan P Mackenbach; José Rubio Valverde; Matthias Bopp; Henrik Brønnum-Hansen; Patrick Deboosere; Ramune Kalediene; Katalin Kovács; Mall Leinsalu; Pekka Martikainen; Gwenn Menvielle; Enrique Regidor; Wilma J Nusselder

doi:10.1016/s2468-2667(19)30147-1

Determinants of inequalities in life expectancy: an international comparative study of eight risk factors

Johan P Mackenbach, José Rubio Valverde, Matthias Bopp, Henrik Brønnum-Hansen, Patrick Deboosere, Ramune Kalediene, Katalin Kovács, Mall Leinsalu, Pekka Martikainen, Gwenn Menvielle, Enrique Regidor, Wilma J Nusselder

Section of Social Medicine

25 Citations (Scopus)

Abstract

BACKGROUND: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities.

METHODS: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions.

FINDINGS: In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor.

INTERPRETATION: Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.

FUNDING: European Commission and Network for Studies on Pensions, Aging, and Retirement.

Original language	English
Journal	The Lancet Public Health
Volume	4
Issue number	10
Pages (from-to)	e529-e537
Number of pages	9
ISSN	2468-2667
DOIs	https://doi.org/10.1016/s2468-2667(19)30147-1
Publication status	Published - Oct 2019

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http://www.thelancet.com/article/S2468266719301471/pdfLicence: CC BY-NC-ND

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Mackenbach, J. P., Valverde, J. R., Bopp, M., Brønnum-Hansen, H., Deboosere, P., Kalediene, R., Kovács, K., Leinsalu, M., Martikainen, P., Menvielle, G., Regidor, E., & Nusselder, W. J. (2019). Determinants of inequalities in life expectancy: an international comparative study of eight risk factors. The Lancet Public Health, 4(10), e529-e537. https://doi.org/10.1016/s2468-2667(19)30147-1

Mackenbach, JP, Valverde, JR, Bopp, M, Brønnum-Hansen, H, Deboosere, P, Kalediene, R, Kovács, K, Leinsalu, M, Martikainen, P, Menvielle, G, Regidor, E & Nusselder, WJ 2019, 'Determinants of inequalities in life expectancy: an international comparative study of eight risk factors', The Lancet Public Health, vol. 4, no. 10, pp. e529-e537. https://doi.org/10.1016/s2468-2667(19)30147-1

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abstract = "BACKGROUND: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities.METHODS: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions.FINDINGS: In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor.INTERPRETATION: Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.FUNDING: European Commission and Network for Studies on Pensions, Aging, and Retirement.",

author = "Mackenbach, {Johan P} and Valverde, {Jos{\'e} Rubio} and Matthias Bopp and Henrik Br{\o}nnum-Hansen and Patrick Deboosere and Ramune Kalediene and Katalin Kov{\'a}cs and Mall Leinsalu and Pekka Martikainen and Gwenn Menvielle and Enrique Regidor and Nusselder, {Wilma J}",

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doi = "10.1016/s2468-2667(19)30147-1",

language = "English",

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T1 - Determinants of inequalities in life expectancy

T2 - an international comparative study of eight risk factors

AU - Mackenbach, Johan P

AU - Valverde, José Rubio

AU - Bopp, Matthias

AU - Brønnum-Hansen, Henrik

AU - Deboosere, Patrick

AU - Kalediene, Ramune

AU - Kovács, Katalin

AU - Leinsalu, Mall

AU - Martikainen, Pekka

AU - Menvielle, Gwenn

AU - Regidor, Enrique

AU - Nusselder, Wilma J

PY - 2019/10

Y1 - 2019/10

N2 - BACKGROUND: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities.METHODS: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions.FINDINGS: In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor.INTERPRETATION: Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.FUNDING: European Commission and Network for Studies on Pensions, Aging, and Retirement.

AB - BACKGROUND: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities.METHODS: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions.FINDINGS: In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor.INTERPRETATION: Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.FUNDING: European Commission and Network for Studies on Pensions, Aging, and Retirement.

U2 - 10.1016/s2468-2667(19)30147-1

DO - 10.1016/s2468-2667(19)30147-1

M3 - Journal article

C2 - 31578987

SN - 2468-2667

VL - 4

SP - e529-e537

JO - The Lancet Public Health

JF - The Lancet Public Health

IS - 10

ER -

Determinants of inequalities in life expectancy: an international comparative study of eight risk factors

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