A decomposition of income-related health inequality applied to EQ-5D Authors
Cite this article as: Gundgaard, J. & Lauridsen, J. Eur J Health Econ (2006) 7: 231. doi:10.1007/s10198-006-0360-3
Income-related inequality in health and its relationship to sociodemographic characteristics have received considerable attention in the health economic literature. Recently a method was suggested for decomposing income-related health inequality to contributions from individual characteristics via additive dimensions, and this was applied to a Finnish case based on 15D health scores, where health is considered to be a sum of 15 individual health dimensions. The present study adds to this literature in several ways. First, we apply the decomposition approach to a Danish case which can be benchmarked to the Finnish. Second, we show how to apply the method to EQ-5D scores, which deviate from 15D scores by expressing health as individual depreciations of an equal endowment of perfect health. Third, we add life-style factors to the determinants of income-related health inequality. The empirical part of the study reveals discrepancies which can be attributed to differences between Finland and Denmark and to differences between the construction of 15D and EQ-5D scores. Finally, evidence of impact of life-style factors on income-related health inequality is found.
Health status index
The Copenhagen declaration on reducing social inequalities in health.
Scand J Public Health Suppl 59: 78–79
Dahlgren G, Whitehead M (2000)
Policies and strategies to promote equity in health. Copenhagen, WHO Regional Office for Europe
Stronks G, Gunning-Schepers LJ (1993)
Should equity in health be target number 1. Eur J Public Health 65: 153–165
Humphries KH, van Doorslaer E (2000)
Income-related health inequality in Canada.
Soc Sci Med 50: 663–671
Kakwani N, Wagstaff A, van Doorslaer E (1997)
Socioeconomic inequalities in health: measurement, computation, and statistical inference.
J Econometrics 77: 87–103
Doorslaer E van, Koolman X (2004)
Explaining the differences in income-related health inequalities across European countries.
Health Econ 13: 609–628
Doorslaer E van, Koolman X, Jones AM (2004)
Explaining income-related inequalities in doctor utilisation in Europe.
Health Econ 13: 629–647
Doorslaer E van, Wagstaff A, Bleichrodt H et al. (1997)
Income-related inequalities in health: some international comparisons.
J Health Econ 16: 93–112
Clarke PM, Gerdtham UG, Connelly LB (2003)
A note on the decomposition of the health concentration index.
Health Econ 12: 511–516
Wagstaff A, van Doorslaer E, Watanabe N (2003)
On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam.
J Econometrics 112: 207–223
Brooks R (1996)
EuroQol: the current state of play.
Health Policy 37: 53–72
Brooks R (1996)
Quality of life measures.
Crit Care Med 24: 1769
Greiner W, Weijnen T, Nieuwenhuizen M et al. (2003)
A single European currency for EQ-5D health states.
Eur J Health Econom 4: 222–231
EuroQol Group (1990)
EuroQol-a new facility for the measurement of health-related quality of life.
Health Policy 16: 199–208
Wittrup-Jensen KU, Lauridsen J, Gudex C et al. (2001)
Estimating Danish EuroQol tariffs using the time trade-off (TTO) and visual analogue scale (VS) methods. In: Norinder AL, Pedersen KM, Roos P (eds) Preceedings of the 18th Plenary Meeting of the EuroQol Group, 6–7 September, Copenhagen, Denmark. Lund: IHE Swedish Institute for Health Economics
Dolan P (1997)
Modeling valuations for EuroQol health states.
Med Care 35: 1095–1108
Dolan P, Gudex C (1995)
Time preference, duration and health state valuations.
Health Econ 4: 289–299
Greiner W, Claes C, Busschbach J, Graf von der Schulenburg J-M (2005)
Validating the EQ-5D with time trade off for the German population.
Eur J Health Econom 6: 124–130
Lauridsen J, Christiansen T, Gundgaard J et al. (2006)
Decomposition of health inequality by determinants and dimensions. Health Econ (in press)
Sintonen H (2001)
The 15D instrument of health-related quality of life: properties and applications.
Ann Med 33: 328–336
Boyle MH, Torrance GW (1984)
Developing multiattribute health indexes.
Med Care 22: 1045–1057
Gundgaard J, Sørensen J (2002)
Evaluering af Fyns Amts Forebyggelsesstrategi: baseline survey om sundhedstilstand og adfaerd omkring tobak, alkohol, kost og motion [Evaluation of the prevention strategy in Funen County: baseline survey on behaviour with respct to tobacco, alcohol, diet and exercise]. Funen County, Odense
Kjøller M, Rasmussen NK (eds) (2002)
Sundhed og sygelighed I Danmark 2000 & udviklingen siden 1987 [Danish health and morbidity survey 2000 & trends since 1989]. National Institute of Public Health, Copenhagen
Ferrucci L, Izmirlian G, Leveille S et al. (1999)
Smoking, physical activity, and active life expectancy.
Am J Epidemiol 149: 645–653
McGinnis JM, Foege WH (1993)
Actual causes of death in the United States.
JAMA 270: 2207–2212
Oguma Y, Sesso HD, Paffenbarger RS Jr, Lee IM (2002)
Physical activity and all cause mortality in women: a review of the evidence.
Br J Sports Med 36: 162–172
Paffenbarger RS Jr, Hyde RT, Wing AL et al. (1993)
The association of changes in physical-activity level and other life style characteristics with mortality among men.
N Engl J Med 328: 538–545
Robertson A, Tirado C, Lobstein T et al. (2004)
Food and health in Europe: a new basis for action. WHO, Copenhagen Copyright information
© Springer Medizin Verlag 2006