Jump to full article: New England Journal of Medicine, 2008-06-05
Author: Berkman, L
Intro: 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
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. . . .
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. . . .
In Europe as a whole, inequalities in mortality from smoking-related conditions account for 21% of the inequalities in the rate of death from any cause among men and 6% of those among women (Table 2). Inequalities in smoking-related mortality tend to be larger in the eastern and Baltic regions (among men only) and smaller (or even "reverse") in the southern region. . . .
In Europe as a whole, both smoking and obesity are more common among people of lower education level; education-related inequalities in smoking are larger among men, and education-related inequalities in obesity are larger among women (Figure 3). There are striking differences among countries in the magnitude and even the direction of these inequalities, however. Large education-related inequalities in smoking are seen in the northern, western, and continental regions; small inequalities (and, among women, even reverse inequalities, in which smoking rates are higher in groups with more education) are seen in the southern region.
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