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How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.

Eikemo TA, Hoffmann R, Kulik MC, Kulhánová I, Toch-Marquardt M, Menvielle G, Looman C, Jasilionis D, Martikainen P, Lundberg O, Mackenbach JP, EURO-GBD-SE Consorti - PLoS ONE (2014)

Bottom Line: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality.On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

ABSTRACT

Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity.

Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor.

Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.

Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

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Related in: MedlinePlus

Potential reduction of relative educational inequalities in all-cause mortality between low and high educated (in %), upward levelling scenario according to social participation, low income and economic inactivity by country and sex.
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pone-0110952-g002: Potential reduction of relative educational inequalities in all-cause mortality between low and high educated (in %), upward levelling scenario according to social participation, low income and economic inactivity by country and sex.

Mentions: We present the impact of upward levelling and best practice scenarios on absolute inequalities in mortality in tables 3 and 4, respectively. Both tables visualize the potential impact across risk factors by use of colours ranging from yellow (none or minor impact) through light green to dark green (major impact). Reductions in relative inequalities for the same scenarios are presented in Figure 1 and Figure 2.


How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.

Eikemo TA, Hoffmann R, Kulik MC, Kulhánová I, Toch-Marquardt M, Menvielle G, Looman C, Jasilionis D, Martikainen P, Lundberg O, Mackenbach JP, EURO-GBD-SE Consorti - PLoS ONE (2014)

Potential reduction of relative educational inequalities in all-cause mortality between low and high educated (in %), upward levelling scenario according to social participation, low income and economic inactivity by country and sex.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219687&req=5

pone-0110952-g002: Potential reduction of relative educational inequalities in all-cause mortality between low and high educated (in %), upward levelling scenario according to social participation, low income and economic inactivity by country and sex.
Mentions: We present the impact of upward levelling and best practice scenarios on absolute inequalities in mortality in tables 3 and 4, respectively. Both tables visualize the potential impact across risk factors by use of colours ranging from yellow (none or minor impact) through light green to dark green (major impact). Reductions in relative inequalities for the same scenarios are presented in Figure 1 and Figure 2.

Bottom Line: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality.On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

ABSTRACT

Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity.

Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor.

Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.

Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

Show MeSH
Related in: MedlinePlus