TY - JOUR
T1 - How can inequalities in mortality be reduced?
T2 - A quantitative analysis of 6 risk factors in 21 European populations
AU - Eikemo, Terje A
AU - Hoffmann, Rasmus
AU - Kulik, Margarete C
AU - Kulhánová, Ivana
AU - Toch-Marquardt, Marlen
AU - Menvielle, Gwenn
AU - Looman, Caspar
AU - Jasilionis, Domantas
AU - Martikainen, Pekka
AU - Lundberg, Olle
AU - Mackenbach, Johan P
AU - EURO-GBD-SE Consortium
AU - Dibben, Chris
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - European Continental Ancestry Group
KW - Female
KW - Health Policy
KW - Humans
KW - Income
KW - Middle Aged
KW - Mortality
KW - Risk Factors
KW - Smoking
KW - Socioeconomic Factors
U2 - 10.1371/journal.pone.0110952
DO - 10.1371/journal.pone.0110952
M3 - Article
C2 - 25369287
VL - 9
SP - e110952
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 11
ER -