FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

A correction has been published: N Engl J Med 2008;359(12):e14.

Previous Volume 358:2468-2481 June 5, 2008 Number 23 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Article as Originally Published Editorial by Berkman, L. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by De Vogli, R. Related Article

ABSTRACT

Background Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.

Methods We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.

Results In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern.

Conclusions We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.

Source Information

From the Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands (J.P.M., I.S., A.-J.R.R., M.M.S., G.M., A.E.K.); INSERM Unité 687, Saint-Maurice, France (G.M.); the Stockholm Center on Health of Societies in Transition, Södertorn University College, Södertorn, Sweden (M.L.); and the Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia (M.L.).

Address reprint requests to Dr. Mackenbach at the Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands, or at j.mackenbach{at}erasmusmc.nl.

Full Text of this Article

This article has been cited by other articles:

• Delpierre, C., Lauwers-Cances, V., Datta, G. D., Berkman, L., Lang, T. (2009). Impact of Social Position on the Effect of Cardiovascular Risk Factors on Self-Rated Health. Am. J. Public Health 99: 1278-1284 [Abstract] [Full Text]  
• Daoud, N., Soskolne, V., Manor, O. (2009). Educational inequalities in self-rated health within the Arab minority in Israel: explanatory factors. Eur J Public Health 0: ckp080v1-ckp080 [Abstract] [Full Text]  
• Lang, T., Delpierre, C. (2009). 'How are you?': what do you mean?. Eur J Public Health 0: ckp083v1-ckp083 [Full Text]  
• Rahu, K., Parna, K., Palo, E., Rahu, M. (2009). Contrasts in Alcohol-Related Mortality in Estonia: Education and Ethnicity. Alcohol Alcohol 0: agp035v1-agp035 [Abstract] [Full Text]  
• Shonkoff, J. P., Boyce, W. T., McEwen, B. S. (2009). Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention. JAMA 301: 2252-2259 [Abstract] [Full Text]  
• Fowler, R. A., Adhikari, N. K. J., Scales, D. C., Lee, W. L., Rubenfeld, G. D. (2009). Update in Critical Care 2008. Am. J. Respir. Crit. Care Med. 179: 743-758 [Full Text]  
• Lai, T., Habicht, J., Kiivet, R.-A. (2009). Measuring burden of disease in Estonia to support public health policy. Eur J Public Health 0: ckp038v1-ckp038 [Abstract] [Full Text]  
• Kirch, D. G., Vernon, D. J. (2009). The Ethical Foundation of American Medicine: In Search of Social Justice. JAMA 301: 1482-1484 [Full Text]  
• Pagano, D, Freemantle, N, Bridgewater, B, Howell, N, Ray, D, Jackson, M, Fabri, B M, Au, J, Keenan, D, Kirkup, B, Keogh, B E, on behalf of the Quality and Outcomes Research Uni, (2009). Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years. BMJ 338: b902-b902 [Abstract] [Full Text]  
• Goldberg, D. S. (2009). In Support of a Broad Model of Public Health: Disparities, Social Epidemiology and Public Health Causation. Public Health Ethics 2: 70-83 [Abstract] [Full Text]  
• Leinsalu, M., Stirbu, I., Vagero, D., Kalediene, R., Kovacs, K., Wojtyniak, B., Wroblewska, W., Mackenbach, J. P, Kunst, A. E (2009). Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. Int J Epidemiol 38: 512-525 [Abstract] [Full Text]  
• Loucks, E. B., Lynch, J. W., Pilote, L., Fuhrer, R., Almeida, N. D., Richard, H., Agha, G., Murabito, J. M., Benjamin, E. J. (2009). Life-Course Socioeconomic Position and Incidence of Coronary Heart Disease: The Framingham Offspring Study. Am J Epidemiol 169: 829-836 [Abstract] [Full Text]  
• Martin-Moreno, J. M, Alonso, P., Claveria, A., Gorgojo, L., Peiro, S. (2009). Spain: a decentralised health system in constant flux. BMJ 338: b1170-b1170 [Full Text]  
• Pascal, J., Abbey-Huguenin, H., Leux, C., Lombrail, P., Lert, F. (2009). Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals. Eur J Public Health 0: ckp033v1-ckp033 [Abstract] [Full Text]  
• Eikemo, T A, Kunst, A E, Judge, K, Mackenbach, J P (2008). Class-related health inequalities are not larger in the East: a comparison of four European regions using the new European socioeconomic classification. J. Epidemiol. Community Health 62: 1072-1078 [Abstract] [Full Text]  
• De Vogli, R., Gimeno, D., Kivimaki, M., Mackenbach, J. P., Stirbu, I., Kunst, A. E. (2008). Socioeconomic Inequalities in Health in 22 European Countries. NEJM 359: 1290-1291 [Full Text]  
• Gorelick, P. B. (2008). Primary Prevention of Stroke: Impact of Healthy Lifestyle. Circulation 118: 904-906 [Full Text]  
• Hunter, D. J, Richards, T. (2008). Health and wealth in Europe. BMJ 336: 1390-1390 [Full Text]  
• (2008). All you need to read in the other general journals. BMJ 336: 1334-1335 [Full Text]  
• Berkman, L., Epstein, A. M. (2008). Beyond Health Care -- Socioeconomic Status and Health. NEJM 358: 2509-2510 [Full Text]