Mortality in the Visegrad countries from the perspective of socioeconomic inequalities
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Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries—the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project.
The associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20–64 years in the 35 NUTS 2 level regions of the V4 in the period 2011–2013 were explored, using linear regression models.
Lower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary.
Despite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.
KeywordsHealth equity Measurement Mortality Socioeconomic inequalities Ecological design Regional differences
Compliance with ethical standards
Conflict of interest
This study was developed within the scope of the investigation project Euro-Healthy “Shaping EUROpean policies to promote HEALTH equitY” which received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 643398. The sole responsibility for the content of this report lies with the authors. It does not necessarily reflect the opinion of the European Union. The European Commission is not responsible for any use that may be made of the information contained therein. Besides, all authors declare that they have no conflict of interest.
The study was performed within the Euro-Healthy project—Shaping EUROpean policies to promote HEALTH equitY (Horizon 2020 No. 643398). The Euro-Healthy project and its results are in compliance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, fundamental ethical principles, rules and standards relevant on European legislation, international conventions and declarations, national authorizations and ethics approvals.
- Avendano M, Berkman LF (2014) Labour markets, employment policies, and health. In: Berkman LF, Kawachi I, Glymour MM (eds) Social epidemiology, 2nd edn. Oxford University Press, New York, pp 182–234Google Scholar
- Bandosz P, O’Flaherty M, Drygas W, Rutkowski M, Koziarek J, Wyrzykowski B, Bennet K, Zdrojewski T, Capewell S (2012) Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study. BMJ 344:d8136–d8136. https://doi.org/10.1136/bmj.d8136 CrossRefPubMedCentralPubMedGoogle Scholar
- Bartley M, Ferrie J, Montgomery SM (2006) Health and labour market disadvantage: unemployment, non-employment, and job insecurity. In: Marmot M, Wilkinson RG (eds) Social determinants of health. Oxford University Press, Oxford, pp 78–96Google Scholar
- Bosakova L (2013) A Bottom-up approach to employment: an example of good practice. WHO Country Office in Slovakia, BratislavaGoogle Scholar
- Bruthans J, Bruthansova D (2009) Kardiovaskularni revoluce. (Cardiovascular revolution). Demografie 51(3):182–189Google Scholar
- Coggon D, Rose G, Barker DJP (2003) Epidemiology for uninitiated. BMJ Publishing Group, MumbaiGoogle Scholar
- Dégano IR, Marrugat J, Grau M, Salvador-Gonzáles B, Ramos R, Zamora A, Martí R, Elosua R (2017) The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index. Sci Rep. https://doi.org/10.1038/s41598-017-10775-3 CrossRefPubMedCentralPubMedGoogle Scholar
- Euro-Healthy (2017) Euro-Healthy data portal. https://eurohealthydata.uc.pt/login.html
- Eurostat (2017a) Causes of death—deaths by NUTS 2 region of residence and occurrence, 3 years average. http://appsso.eurostat.ec.europa.eu/nui/show.do?wai=true&dataset=hlth_cd_yro
- Eurostat (2017b) Unemployment rate—annual data. http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&language=en&pcode=tipsun20&plugin=1
- Halliday TJ (2013) Unemployment and mortality: evidence from the PSID. IZA DP No. 7157Google Scholar
- Healthy Power Action (2017) https://www.healthpovertyaction.org/info-and-resources/the-cycle-of-poverty-and-poor-health/key-facts/
- Herbst M, Wojciuk A (2014) Common origin, different paths, transformation of education systems in the Czech Republic, Slovakia, Hungary and Poland. GRINCOH working paper series, paper no. 4.07. https://doi.org/10.13140/2.1.1995.0085
- Kacerova M, Novakova M (2016) Vplyv populacnych procesov na starnutie obyvatelstva v krajinách V4. (The impact of population processes on population ageing in the V4 countries). Sl Stat Demogr 26(2):47–62Google Scholar
- Kebza M, Kubes J, Novacek A (2015) Vychodo-zapadni gradient socialni a ekonomicke prostorove diferenciace Madarska. (East-west gradient of social and economic space differentiation in Hungary). In: Klimova V, Zitek V (ed) 18th International colloquium on regional sciences, conference proceedings, Masaryk University, Hustopece, pp 41–48Google Scholar
- Kiss J (2015) Prospects of the Visegrad cooperation in changing economic, political and social conditions—identifying converging and diverging factors. In: Tury G (ed) Prospects of the Visegrad cooperation. Identifying converging and diverging factors. Institute of World Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Budapest, pp 329–367Google Scholar
- Leinsalu M, Stirbu I, Vagero D, Kalediene R, Kovacs K, Wojtyniak B, Wroblewska W, Mackenbach JP, Kunst AE (2009) Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. Int J Epidemiol 38(2):512–525. https://doi.org/10.1093/ije/dyn248 CrossRefPubMedGoogle Scholar
- Mackenbach J (2006) Health inequalities: Europe in profile. COI for the Department of Health, UK. http://dh.gov.uk/publications
- Marmot M (2010) Fair society, healthy lives: The Marmot Review: strategic review of health inequalities in England post-2010: The Marmot Review, University College LondonGoogle Scholar
- Santana P, Costa C, Freitas A, Stefanik I, Quintal C, Bana e Costa C, Borrell C, Dimitroulopoulou S, Lopes Ferreira P, Krafft T, Oliveira M, Pikhart H, Rican S, Vardoulakis S, Almendra R, Bana e Costa J, Bosakova L, Burstrom B, Corman D, Costa G, Cunha L, Deboosere P, Drbohlav D, Dzurova D, Franke C, Freitas L, Gama R, Gotsens M, Hadewijch V, Hajduova Z, Heaviside C, Jose Malva J, Katsouyanni K, Lopes A, Lustigova M, Mari-Dell´Olmo M, Michelsen K, Mitsakou CH, Morrison J, Nossa P, Palencia L, Patriarca J, Pieper J, Pilot E, Rodopoulou S, Rodrigues T, Rodriguez-Sanz M, Rosicova K, Salem G, Samoli E, Schweikart J, Tavares AI, Tenailleau Q, Tkac M, Ueberschar N (2017) Atlas of population health in European Union regions. Imprensa da Universidade de Coimbra. ISBN 978-989- 26-1462- 5Google Scholar
- Stevens P (2004) Diseases of poverty and the 10/90 gap. International Policy Network, LondonGoogle Scholar
- The Commission in social determinants of health (CSDH) (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the commission on social determinants of health, World Health Organization, GenevaGoogle Scholar
- Vandenheede H, Vikhireva O, Pikhart H, Kubinova R, Malyutina S, Pajak A, Tamosiunas A, Peasey A, Simonova G, Topor-Madry R, Marmot M, Bobak M (2014) Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study. J Epidemiol Community Health 68(4):297–303. https://doi.org/10.1136/jech-2013-203057 CrossRefPubMedGoogle Scholar
- World Health Organization (WHO) (2017) Cardiovascular diseases (CVDs). Fact sheet. http://www.who.int/mediacentre/factsheets/fs317/en/