The contribution of educational inequalities to lifespan variation

Van, Kunst, Lundberg Olle, Leinsalu Mall, Martikainen Pekka, Artnik Barbara, Deboosere Patrick, Stirbu Irina, Wojtyniak Bogdan, Mackenbach

Description

Studies of socioeconomic inequalities in mortality consistently point to higher death rates in lower socioeconomic groups. Yet how these between-group differences relate to the total variation in mortality risk between individuals is unknown. Methods We used data assembled and harmonized as part of the Eurothine project, which includes census-based mortality data from 11 European countries. We matched this to national data from the Human Mortality Database and constructed life tables by gender and educational level. We measured variation in age at death using Theil's entropy index, and decomposed this measure into its between- and within-group components. Results The least-educated groups lived between three and 15 years fewer than the highest-educated groups, the latter having a more similar age at death in all countries. Differences between educational groups contributed between 0.6% and 2.7% to total variation in age at death between individuals in Western European countries and between 1.2% and 10.9% in Central and Eastern European countries. Variation in age at death is larger and differs more between countries among the least-educated groups. Conclusions At the individual level, many known and unknown factors are causing enormous variation in age at death, socioeconomic position being only one of them. Reducing variations in age at death among less-educated people by providing protection to the vulnerable may help to reduce inequalities in mortality between socioeconomic groups.

Sujets

• Life expectancy
• Éducation
• Mortality

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 9
• Langue: English

Extrait

van Raalteet al.Population Health Metrics2012,10:3 http://www.pophealthmetrics.com/content/10/1/3

R E S E A R C HOpen Access The contribution of educational inequalities to lifespan variation 1,2* 3 4,56,7 89 Alyson A van Raalte, Anton E Kunst , Olle Lundberg, Mall Leinsalu, Pekka Martikainen , Barbara Artnik , 10 211 2 Patrick Deboosere, Irina Stirbu , Bogdan Wojtyniakand Johan P Mackenbach

Abstract Background:Studies of socioeconomic inequalities in mortality consistently point to higher death rates in lower socioeconomic groups. Yet how these betweengroup differences relate to the total variation in mortality risk between individuals is unknown. Methods:We used data assembled and harmonized as part of the Eurothine project, which includes censusbased mortality data from 11 European countries. We matched this to national data from the Human Mortality Database and constructed life tables by gender and educational level. We measured variation in age at death using Theil’s entropy index, and decomposed this measure into its between and withingroup components. Results:The leasteducated groups lived between three and 15 years fewer than the highesteducated groups, the latter having a more similar age at death in all countries. Differences between educational groups contributed between 0.6% and 2.7% to total variation in age at death between individuals in Western European countries and between 1.2% and 10.9% in Central and Eastern European countries. Variation in age at death is larger and differs more between countries among the leasteducated groups. Conclusions:At the individual level, many known and unknown factors are causing enormous variation in age at death, socioeconomic position being only one of them. Reducing variations in age at death among lesseducated people by providing protection to the vulnerable may help to reduce inequalities in mortality between socioeconomic groups. Keywords:Lifespan variation, Life expectancy, Socioeconomic inequality, Education, International variation, Mortality

Introduction Individuals vary greatly in lifespan. For instance, compar ing the age at death of European males at the individual level to that of every other male in the same country, the average difference is around 7.5 to 10.5 years, depending a on the country.This variation in lifespan has many sources, including genetic factors, lifestyle factors, socioe conomic conditions, chance, etc. One of these sources, differential mortality by socioeconomic group, has been the subject of much research. A recent European cross country comparison revealed higher death rates in lower educational groups in all 16 populations studied, with particularly large educational differences in mortality in

* Correspondence: [e-mail] 1 Max Planck Institute for Demographic Research, Rostock, Germany Full list of author information is available at the end of the article

parts of Central and Eastern Europe [1]. What is unknown, however, is the contribution of thesebetween groupdifferences to allbetweenindividualdifferences. This relates to the debate sparked by the release of the World Health Report 2000 about whether lifespan (or more broadly health) inequality should be measured over individuals or groups, with the report’s authors coming out in favor of the former [24]. By quantifying the varia tion of health over all individuals in a population, they contended, a more comprehensive inquiry into the extent of health inequality could be made than by conventional methods that quantify health inequalities as differences between predefined social groups. The authors further cri ticized methods that exclusively compared group means, speculating that different socioeconomic groups might also have different degrees of withingroup variation.

© 2012 van Raalte et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.