Abstrakt
Inequalities in mortality and morbidity among socioeconomic groups are a highly persistent phenomenon despite having been the focus of public health policy in many countries. The United States has recently witnessed a widening of health inequalities due to rising mortality and morbidity among the lowly educated.
Health trends by education in European countries were analysed, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. Harmonized data on mortality from ca. 1980 to ca. 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca. 2002 to ca. 2014 for 27 countries covering 350,000 survey respondents were collected.
Interrupted timeseries analyses were used in order to study changes over time and country-fixed effects analyses to examine the impact of crisis-related economic conditions on health outcomes. Recent trends were more favourable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities.
In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis related economic conditions were not associated with widening health inequalities.
The results show that the unfavourable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level.
Findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.