Trends in health inequalities in 27 European countries

Johan P Mackenbach; José Rubio Valverde; Barbara Artnik; Matthias Bopp; Henrik Brønnum-Hansen; Patrick Deboosere; Ramune Kalediene; Katalin Kovács; Mall Leinsalu; Pekka Martikainen; Gwenn Menvielle; Enrique Regidor; Jitka Rychtaříková; Maica Rodriguez-Sanz; Paolo Vineis; Chris White; Bogdan Wojtyniak; Yannan Hu; Wilma J Nusselder

doi:10.1073/pnas.1800028115

Trends in health inequalities in 27 European countries

Johan P Mackenbach, José Rubio Valverde, Barbara Artnik, Matthias Bopp, Henrik Brønnum-Hansen, Patrick Deboosere, Ramune Kalediene, Katalin Kovács, Mall Leinsalu, Pekka Martikainen, Gwenn Menvielle, Enrique Regidor, Jitka Rychtaříková, Maica Rodriguez-Sanz, Paolo Vineis, Chris White, Bogdan Wojtyniak, Yannan Hu, Wilma J Nusselder

Section of Social Medicine

54 Citations (Scopus)

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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 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.

Original language	English
Journal	Proceedings of the National Academy of Sciences of the United States of America
Volume	115
Issue number	25
Pages (from-to)	6440-6445
Number of pages	6
ISSN	0027-8424
DOIs	https://doi.org/10.1073/pnas.1800028115
Publication status	Published - 19 Jun 2018

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Mackenbach, J. P., Valverde, J. R., Artnik, B., Bopp, M., Brønnum-Hansen, H., Deboosere, P., Kalediene, R., Kovács, K., Leinsalu, M., Martikainen, P., Menvielle, G., Regidor, E., Rychtaříková, J., Rodriguez-Sanz, M., Vineis, P., White, C., Wojtyniak, B., Hu, Y., & Nusselder, W. J. (2018). Trends in health inequalities in 27 European countries. Proceedings of the National Academy of Sciences of the United States of America, 115(25), 6440-6445. https://doi.org/10.1073/pnas.1800028115

Mackenbach, JP, Valverde, JR, Artnik, B, Bopp, M, Brønnum-Hansen, H, Deboosere, P, Kalediene, R, Kovács, K, Leinsalu, M, Martikainen, P, Menvielle, G, Regidor, E, Rychtaříková, J, Rodriguez-Sanz, M, Vineis, P, White, C, Wojtyniak, B, Hu, Y & Nusselder, WJ 2018, 'Trends in health inequalities in 27 European countries', Proceedings of the National Academy of Sciences of the United States of America, vol. 115, no. 25, pp. 6440-6445. https://doi.org/10.1073/pnas.1800028115

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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 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.",

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AU - Mackenbach, Johan P

AU - Valverde, José Rubio

AU - Artnik, Barbara

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 - Rychtaříková, Jitka

AU - Rodriguez-Sanz, Maica

AU - Vineis, Paolo

AU - White, Chris

AU - Wojtyniak, Bogdan

AU - Hu, Yannan

AU - Nusselder, Wilma J

PY - 2018/6/19

Y1 - 2018/6/19

N2 - 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.

AB - 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.

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DO - 10.1073/pnas.1800028115

M3 - Journal article

C2 - 29866829

SN - 0027-8424

VL - 115

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EP - 6445

JO - Proceedings of the National Academy of Sciences of the United States of America

JF - Proceedings of the National Academy of Sciences of the United States of America

IS - 25

ER -

Trends in health inequalities in 27 European countries

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