ArticlesSocioeconomic inequalities in morbidity and mortality in western Europe*
Introduction
Socioeconomic inequalities in health have been reported to vary between countries,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 although comparative studies have methodological drawbacks. Thus looking for conditions that reduce health inequalities is difficult. We have done a large between-country comparison of inequalities in mortality and morbidity in western Europe in which we tried to overcome some of these difficulties. Our full-length report was published in 1996.12
Section snippets
Morbidity
Data on morbidity were obtained from nationally representative health interview, level of living, or multipurpose surveys in 11 countries (table 1) over 1985–92 covering around 5000–132 000 (median about 11 000) respondents. Generally, institutionalised populations were excluded in the surveys. We report on persons aged 25–69. Great Britain comprises England, Wales, and Scotland. Germany means the former West Germany.
We selected four health indicators to compare countries: perceived general
Morbidity
For inequalities in morbidity within countries, for men, the odds ratios by level of education ranged from about 1·3 to 2·6 (table 1). For perceived general health, for instance, eight of the 11 countries had odds ratios of almost 2 or higher. The 95% CIs indicate that inequalities for this measure were larger in Norway than in Switzerland or Spain. For long-term disabilities we could not obtain data for all the countries, but Switzerland was better off than Norway or the Netherlands.
The
Discussion
Countries in western Europe were generally similar in the size of socioeconomic inequalities in health. In all countries, risks of morbidity and mortality were higher in the lower socioeconomic groups. Surprisingly, we found that relative inequalities were larger than average in Sweden and Norway (both for morbidity and mortality). France had the highest inequality for mortality.
Large inequalities for morbidity have been reported in the Nordic countries and the Netherlands,1, 4 but one study
References (30)
- et al.
Comparison of inequalities in health: evidence from national surveys in Finland, Norway and Sweden
Soc Sci Med
(1994) Class and health: comparing Britain and Sweden
Soc Sci Med
(1986)- et al.
Health inequalities in Britain and Sweden
Lancet
(1989) - et al.
On the measurement of inequalities in health
Soc Sci Med
(1991) - et al.
Measuring the magnitude of socioeconomic inequalities in health: an overview of available measures illustrated with two examples from Europe
Soc Sci Med
(1997) - et al.
Increased socioeconomic differences in mortality in eight Spanish provinces
Soc Sci Med
(1995) - et al.
International variation of socioeconomic inequalities in self-reported health
J Epidemiol Community Health
(1995) - et al.
The size of mortality differences associated with educational level in nine industrialized countries
Am J Public Health
(1994) - et al.
International variation in the size of mortality differences associated with occupational status
Int J Epidemiol
(1994) - et al.
Health inequalities among men and women in contrasting welfare states: Britain and three Nordic countries compared
Eur J Public Health
(1994)
Differential mortality: some comparisons between England and Wales, Finland and France, based on inequalities measures
Int J Epidemiol
Conceptual and methodological discussion of transnational comparisons of socio-economic mortality differences, and an example
Adult mortality and level of education: a comparison of six countries
EU Working Group on Socio-economic Inequalities in Health. Socio-economic inequalities in morbidity and mortality in Europe: a comparative study
Education in OECD countries 1987–89. A compendium of statistical information: 1990 special edition
Cited by (951)
Examining associations between social vulnerability indices and COVID-19 incidence and mortality with spatial-temporal Bayesian modeling
2024, Spatial and Spatio-temporal EpidemiologyInter-regional environmental inequality under lasting pandemic exacerbated by residential response
2023, Science of the Total EnvironmentAmplified disparities: The association between spousal education and own health
2023, Social Science and Medicine
- *
Listed at end of article