International Journal of Public Health

, Volume 63, Issue 4, pp 469–479 | Cite as

Does community deprivation determine longevity after the age of 75? A cross-national analysis

  • Ana Isabel Ribeiro
  • Elias Teixeira Krainski
  • Marilia Sá Carvalho
  • Guy Launoy
  • Carole Pornet
  • Maria de Fátima de Pina
Original Article



Analyze the association between socioeconomic deprivation and old-age survival in Europe, and investigate whether it varies by country and gender.


Our study incorporated five countries (Portugal, Spain, France, Italy, and England). A 10-year survival rate expressing the proportion of population aged 75–84 years who reached 85–94 years old was calculated at area-level for 2001–11. To estimate associations, we used Bayesian spatial models and a transnational measure of deprivation. Attributable/prevention fractions were calculated.


Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a dose–response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were even weaker. The elimination of socioeconomic differences between areas would increase survival by 7.1%, and even a small reduction in socioeconomic differences would lead to a 1.6% increase.


Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.


Ageing Elderly Health inequalities Social factors Europe Longevity Mortality 



This work was supported by Portuguese funds through FCT—Fundação para a Ciência e a Tecnologia in the framework of project UID/BIM/04293/2013. AIR and MFP would also like to thank to FC—Fundação para a Ciência e a Tecnologia for the Grants PTDC/SAU-EPI/113424/2009 and SFRH/BD/82529/2011. MSC was supported by CNpQ (309692/2013-0) and FAPERJ (E-26/203.557/2014).We are very grateful to the National Statistic Offices for sending us the required data and to all the members of the European Deprivation Index (EDI) team. The authors would like to thank Rogério Ribeiro for the help in preparing visual supports, Alexandra Guttentag for her work as language editor, and the anonymous reviewers for their highly valuable corrections and suggestions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

38_2018_1081_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)


  1. Asada Y (2010) On the choice of absolute or relative inequality measures. Milbank Q 88:616–622. CrossRefPubMedPubMedCentralGoogle Scholar
  2. Bambra C (2011) Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’. J Epidemiol Community Health 65:740–745. CrossRefPubMedGoogle Scholar
  3. Borrell C, Mari-Dell’olmo M, Palencia L, Gotsens M, Burstrom BO, Dominguez-Berjon F, Rodriguez-Sanz M, Dzurova D, Gandarillas A, Hoffmann R, Kovacs K, Marinacci C, Martikainen P, Pikhart H, Corman D, Rosicova K, Saez M, Santana P, Tarkiainen L, Puigpinos R, Morrison J, Pasarin MI, Diez E (2014) Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health 42:245–254. CrossRefPubMedGoogle Scholar
  4. Brennenstuhl S, Quesnel-Vallee A, McDonough P (2012) Welfare regimes, population health and health inequalities: a research synthesis. J Epidemiol Community Health 66:397–409. CrossRefPubMedGoogle Scholar
  5. Bryere J, Pornet C, Dejardin O, Launay L, Guittet L, Launoy G (2015) Correction of misclassification bias induced by the residential mobility in studies examining the link between socioeconomic environment and cancer incidence. Cancer Epidemiol 39:256–264. CrossRefPubMedGoogle Scholar
  6. Dahl E, van der Wel KA (2013) Educational inequalities in health in European welfare states: a social expenditure approach. Soc Sci Med 81:60–69. CrossRefPubMedGoogle Scholar
  7. Dalstra J, Kunst A, Geurts J, Frenken F, Mackenbach J (2002) Trends in socioeconomic health inequalities in the Netherlands, 1981–1999. J Epidemiol Community Health 56:927–934. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Eayres D, Williams E (2004) Evaluation of methodologies for small area life expectancy estimation. J Epidemiol Community Health 58:243–249. CrossRefPubMedPubMedCentralGoogle Scholar
  9. Engelman M, Canudas-Romo V, Agree EM (2010) The implications of increased survivorship for mortality variation in aging populations. Popul Dev Rev 36:511–539. CrossRefPubMedGoogle Scholar
  10. Fouweather T, Gillies C, Wohland P, Van Oyen H, Nusselder W, Robine J-M, Cambois E, Jagger C (2015) Comparison of socio-economic indicators explaining inequalities in healthy life years at age 50 in Europe: 2005 and 2010. Eur J Public Health. PubMedGoogle Scholar
  11. Gotsens M et al (2013) Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place 24:165–172. CrossRefPubMedGoogle Scholar
  12. Green MA (2013) The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010. Soc Sci Med 87:93–98. CrossRefPubMedGoogle Scholar
  13. Guillaume E, Pornet C, Dejardin O, Launay L, Lillini R, Vercelli M, Marí-Dell’Olmo M, Fernández Fontelo A, Borrell C, Ribeiro AI, Pina MFd, Mayer A, Delpierre C, Rachet B, Launoy G (2015) Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health. PubMedPubMedCentralGoogle Scholar
  14. Hoffmann R et al (2014) Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr 13:8. CrossRefPubMedPubMedCentralGoogle Scholar
  15. House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR (1994) The social stratification of aging and health. J Health Soc Behav 35:213–234. CrossRefPubMedGoogle Scholar
  16. Huisman M, Kunst AE, Andersen O, Bopp M, Borgan JK, Borrell C, Costa G, Deboosere P, Desplanques G, Donkin A, Gadeyne S, Minder C, Regidor E, Spadea T, Valkonen T, Mackenbach JP (2004) Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health 58:468–475CrossRefPubMedPubMedCentralGoogle Scholar
  17. Huisman M, Read S, Towriss CA, Deeg DJ, Grundy E (2013) Socioeconomic inequalities in mortality rates in old age in the world health organization Europe region. Epidemiol Rev 35:84–97. CrossRefPubMedGoogle Scholar
  18. Jakubowski E, Busse R, Chambers GR (1998) Health Care Systems in The EU a Comparative Study. European ParliamentGoogle Scholar
  19. Kim J (2014) Association between social factors of health ageing and longevity: determinants of the Longevity Index (LI) in OECD Countries. Ageing Int 39:97–105. CrossRefGoogle Scholar
  20. Koskinen S, Martelin T (1994) Why are socioeconomic mortality differences smaller among women than among men? Soc Sci Med 38:1385–1396CrossRefPubMedGoogle Scholar
  21. Kringos DS, Boerma WGW, van der Zee J, Groenewegen PP (2013) Political, cultural and economic foundations of primary care in Europe. Soc Sci Med 99:9–17. CrossRefPubMedGoogle Scholar
  22. Lundberg O, Yngwe MÅ, Stjärne MK, Elstad JI, Ferrarini T, Kangas O, Norström T, Palme J, Fritzell J (2008) The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study. Lancet 372:1633–1640. CrossRefPubMedGoogle Scholar
  23. Mackenbach JP, Kunst AE (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44:757–771. CrossRefPubMedGoogle Scholar
  24. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481. CrossRefPubMedGoogle Scholar
  25. Mackenbach JP, Hu Y, Artnik B, Bopp M, Costa G, Kalediene R, Martikainen P, Menvielle G, Strand BH, Wojtyniak B, Nusselder WJ (2017) Trends in inequalities in mortality amenable to health care In 17 European Countries Health affairs (Project Hope) 36:1110-1118
  26. Mari-Dell’Olmo M, Gotsens M, Palencia L, Burstrom B, Corman D, Costa G, Deboosere P, Diez E, Dominguez-Berjon F, Dzurova D, Gandarillas A, Hoffmann R, Kovacs K, Martikainen P, Demaria M, Pikhart H, Rodriguez-Sanz M, Saez M, Santana P, Schwierz C, Tarkiainen L, Borrell C (2015) Socioeconomic inequalities in cause-specific mortality in 15 European cities. J Epidemiol Community Health 69:432–441. CrossRefPubMedGoogle Scholar
  27. Martino S, Rue H (2009) Implementing approximate bayesian inference using integrated nested laplace approximation: a manual for the inla program https://www.mathntnuno/~hrue/GMRFsim/manualpdf
  28. Meyer JW, Speare A (1985) Distinctively elderly mobility: types and determinants. Econ Geogr 61:79–88CrossRefPubMedGoogle Scholar
  29. Mustard C, Etches J (2003) Gender differences in socioeconomic Inequality in mortality. J Epidemiol Community Health 57:974–980. CrossRefPubMedPubMedCentralGoogle Scholar
  30. Niedzwiedz CL, Pell JP, Mitchell R (2015) The relationship between financial distress and life-course socioeconomic inequalities in well-being: cross-national analysis of European Welfare States. Am J Public Health 105:2090–2098. CrossRefPubMedPubMedCentralGoogle Scholar
  31. OECD (2017) Net pension replacement rates (indicator). (Accessed on 26 November 2017)Google Scholar
  32. Port CL, Gruber-Baldini AL, Burton L, Baumgarten M, Hebel JR, Zimmerman SI, Magaziner J (2001) Resident contact with family and friends following nursing home admission. Gerontologist 41:589–596CrossRefPubMedGoogle Scholar
  33. Ribeiro AI, Krainski ET, Carvalho MS, Pina MDFD (2016) Where do people live longer and shorter lives? An ecological study of old-age survival across 4404 small areas from 18 European countries. J Epidemiol Community Health. Google Scholar
  34. Ribeiro AI, Mayer A, Miranda A, Pina MF (2017) The portuguese version of the European Deprivation Index: an instrument to study health inequalities. Acta Médica Portuguesa 30:17–25CrossRefPubMedGoogle Scholar
  35. Richardson EA, Pearce J, Mitchell R, Shortt NK, Tunstall H (2013) Have regional inequalities in life expectancy widened within the European Union between 1991 and 2008? Eur J Public Health 24:357–363CrossRefPubMedGoogle Scholar
  36. Rockhill B, Newman B, Weinberg C (1998) Use and misuse of population attributable fractions. Am J Public Health 88:15–19CrossRefPubMedPubMedCentralGoogle Scholar
  37. Rue H, Held L, Raton B (2005) Gaussian Markov random fields: theory and applications. Chapman & Hall/CRC, Boca RatonCrossRefGoogle Scholar
  38. Rue H, Martino S, Lindgren F, Simpson D, Riebler A (2009) INLA: Functions which allow to perform full Bayesian analysis of latent Gaussian models using Integrated Nested Laplace Approximaxion. R Package VersionGoogle Scholar
  39. Stringhini S et al (2017) Socioeconomic status and the 25  ×  25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1 7 million men and women. Lancet 389:1229–1237. CrossRefPubMedPubMedCentralGoogle Scholar
  40. Susser M (1993) Health as a human right: an epidemiologist’s perspective on the public health. Am J Public Health 83:418–426CrossRefPubMedPubMedCentralGoogle Scholar
  41. Tatsiramos K (2006) Residential Mobility and Housing Adjustment of Older Households in Europe IZA Discussion Papers p 1–27Google Scholar
  42. Taulbut M, Walsh D, McCartney G, Parcell S, Hartmann A, Poirier G, Strniskova D, Hanlon P (2014) Spatial inequalities in life expectancy within postindustrial regions of Europe: a cross-sectional observational study. BMJ Open. PubMedPubMedCentralGoogle Scholar
  43. Wohland P, Rees P, Gillies C, Alvanides S, Matthews FE, O’Neill V, Jagger C (2014) Drivers of Inequality in disability-free expectancy at birth and age 85 across space and time in Great Britain. J Epidemiol Community Health 68:826–833. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Ana Isabel Ribeiro
    • 1
    • 2
    • 3
    • 4
  • Elias Teixeira Krainski
    • 5
    • 6
  • Marilia Sá Carvalho
    • 7
  • Guy Launoy
    • 8
  • Carole Pornet
    • 9
  • Maria de Fátima de Pina
    • 2
    • 3
    • 10
    • 11
  1. 1.EPIUnit-Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
  2. 2.i3S-Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
  3. 3.INEB-Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
  4. 4.Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de MedicinaUniversidade do PortoPortoPortugal
  5. 5.The Norwegian University for Science and TechnologyTrondheimNorway
  6. 6.Departamento de EstatísticaUniversidade Federal do ParanáCuritibaBrazil
  7. 7.PROCC-Programa de Computação Científica, Fundação Oswaldo CruzRio De JaneiroBrazil
  8. 8.U1086 INSERM-University of Caen Normandy (FRANCE), CHU CaenCaenFrance
  9. 9.Public Health DepartmentRegional Health Agency of NormandyCaenFrance
  10. 10.ICICT/FIOCRUZ, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo CruzRio De JaneiroBrazil
  11. 11.CARTO, FEN/UERJ, Departamento de Engenharia Cartográfica, Faculdade de Engenharia da, Universidade do Estado do Rio de JaneiroRio De JaneiroBrazil

Personalised recommendations