Advertisement

Zeitschrift für Gerontologie und Geriatrie

, Volume 52, Issue 2, pp 122–129 | Cite as

Vor dem Tod sind alle ungleich

30 Jahre Forschung zu Mortalitätsunterschieden nach Sozialstatus im europäischen Ländervergleich
  • Matthias BoppEmail author
  • Johan P. Mackenbach
Themenschwerpunkt
  • 30 Downloads

Zusammenfassung

Hintergrund

Im Jahr 1989 erschienen die ersten Ländervergleiche zu Mortalitätsunterschieden nach Bildung und Berufsstatus. Wenige Jahre später begannen die systematischen Ländervergleiche an der Erasmus-Universität in Rotterdam, die mehrere europäische Kollaborationsprogramme zur Erforschung sozialer Unterschiede in der Gesundheit auslösten. Dabei zeigten sich markante Sterblichkeitsunterschiede in und zwischen europäischen Populationen.

Zielsetzung

Diese Arbeit soll eine Synthese der wichtigsten Forschungsresultate aus den letzten 30 Jahren liefern und auf noch bestehende Lücken und Potenziale hinweisen.

Material und Methoden

Deskriptive Synthese der Forschungsresultate aus europäischen Ländervergleichen der Gesamt- und ursachenspezifischen Sterblichkeit nach Geschlecht, Bildungsstand und Berufsstatus.

Ergebnisse

Überall in Europa zeigt sich ein konsistentes Gefälle mit erheblichen und teilweise zunehmenden Vorteilen für statushöhere Gruppen – allerdings mit beträchtlichen Unterschieden zwischen den einzelnen Ländern. Dies gilt auch für Trends und todesursachenspezifische Auswertungen. Die relativen Unterschiede haben praktisch durchwegs zugenommen, die absoluten dagegen bei etlichen Populationen abgenommen. Bei Frauen und mit zunehmendem Alter sind die relativen Unterschiede kleiner. Innerhalb Europas sind die Unterschiede im Süden am geringsten und im Osten am größten. Eine besondere Rolle für die Trends und Gradienten spielen die tabak- und alkoholassoziierten Krankheiten.

Schlussfolgerung

Die Evidenz für soziale Unterschiede im Gesundheitszustand und ihre Determinanten hat sich in den letzten 30 Jahren signifikant verbessert. In Zukunft sind wichtige weitere Fragestellungen denkbar, z. B. welche Lebensphasen wie viel beitragen für ein gesundes Altern.

Schlüsselwörter

Differenzielle Mortalität Bildungsstand Berufsstatus Gesundheitliche Unterschiede Lebenserwartung 

Death is a respecter of persons

30 years of research comparing European countries regarding social inequality in mortality

Abstract

Background

In 1989 the first international comparisons of mortality differences according to educational level and occupational status were published. A few years later systematic comparisons between European countries were initiated at the Erasmus University in Rotterdam. This became a trigger for several European Union (EU)-funded collaboration programs scrutinizing social inequalities in health. The collaboration revealed substantial differences in mortality within and between European populations.

Objective

This article provides a synthesis of the most important research results over the past 30 years and also identifies existing research gaps and potentials.

Material and methods

Descriptive summary of research results comparing European countries regarding male and female all-cause and cause-specific mortality according to educational level and occupational status.

Results

In all European populations analyzed there was a consistent gradient with substantial and in part increasing advantages for higher socioeconomic status groups. There is, however, substantial variation between individual countries. This also applies to trends and cause of death-specific analyses. While relative differences have increased in virtually all populations, absolute differences have often decreased in many populations. Among women and in higher ages the relative differences were smaller. Within Europe, the southern countries had the smallest and the eastern countries the largest gradients. Tobacco and alcohol-related diseases had an especially noteworthy impact on trends and gradients.

Conclusion

The evidence for social health inequalities and their determinants has substantially improved during the past 30 years; however, there remains substantial potential for future research questions, for example concerning the contribution of the different phases of life to healthy aging.

Keywords

Differential mortality Educational status Occupational status Health inequalities Life expectancy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Bopp und J.P. Mackenbach geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Antonovsky A (1967) Social class, life expectancy and overall mortality. Milbank Mem Fund Q 45(2/1):31–73CrossRefGoogle Scholar
  2. 2.
    Barker DJP (2003) The developmental origins of adult disease. Eur J Epidemiol 18:733–736CrossRefGoogle Scholar
  3. 3.
    Ben-Shlomo Y, Cooper R, Kuh D (2016) The last two decades of life course epidemiology, and its relevance for research on ageing. Int J Epidemiol 45:973–988CrossRefGoogle Scholar
  4. 4.
    Black D, Morris JN, Smith C, Townsend P (1980) Inequalities in health: report of a research working group (black report). Dept. of Health and Social Security, LondonGoogle Scholar
  5. 5.
    Bopp M, Minder CE (2003) Mortality by education in German speaking Switzerland, 1990–1997: results from the Swiss National Cohort. Int J Epidemiol 32:346–354CrossRefGoogle Scholar
  6. 6.
    Cavelaars AEJM, Kunst AE, Mackenbach JP (1997) Socio-economic differences in risk factors for morbidity and mortality in the European Community. An international comparison. J Health Psychol 2:353–372CrossRefGoogle Scholar
  7. 7.
    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. WHO, GenevaGoogle Scholar
  8. 8.
    Davey Smith G, Hart C, Blane D, Hole D (1998) Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study. Br Med J 316:1631–1635CrossRefGoogle Scholar
  9. 9.
    Gadeyne S, Menvielle G, Kulhanova I et al (2017) The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s. Int J Cancer 141:33–44CrossRefGoogle Scholar
  10. 10.
    de Gelder R, Menvielle G, Costa G et al (2017) Long-term trends in socioeconomic inequalities in mortality in 6 European countries. Int J Public Health 62:127–141CrossRefGoogle Scholar
  11. 11.
    Gregoraci G, van Lenthe FJ, Artnik B et al (2017) Contribution of smoking to socio-economic inequalities in mortality: a study of 14 European countries, 1990–2004. Tob Control 26:260–268CrossRefGoogle Scholar
  12. 12.
    van Hedel K, van Lenthe FJ, Groeniger JO, Mackenbach JP (2018) What’s the difference? A gender perspective on understanding educational inequalities in all-cause and cause-specific mortality. BMC Public Health 18:1105CrossRefGoogle Scholar
  13. 13.
    Héritier H, Vienneau D, Foraster M et al (2017) Transportation noise exposure and cardiovascular mortality: a nationwide cohort study from Switzerland. Eur J Epidemiol 32:307–315CrossRefGoogle Scholar
  14. 14.
    Hoffmann R, Eikemo TA, Kulhanova I et al (2013) The potential impact of a social redistribution of specific risk factors on socioeconomic inequalities in mortality: illustration of a method based on population attributable fractions. J Epidemiol Community Health 67:56–62CrossRefGoogle Scholar
  15. 15.
    Hoffmann R, Hu Y, de Gelder R et al (2016) The impact of increasing income inequalities on educational inequalities in mortality—an analysis of six European countries. Int J Equity Health 15:103CrossRefGoogle Scholar
  16. 16.
    Huisman M, Kunst AE, Bopp M et al (2005) Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 365:493–500CrossRefGoogle Scholar
  17. 17.
    Kulik MC, Menvielle G, Eikemo TA et al (2014) Educational inequalities in three smoking-related causes of death in 18 European populations. Nicotine Tob Res 16(5):507–518CrossRefGoogle Scholar
  18. 18.
    Kunst AE, Mackenbach JP (1994a) International variation in the size of mortality differences associated with occupational status. Int J Epidemiol 23:742–750CrossRefGoogle Scholar
  19. 19.
    Kunst AE, Mackenbach JP (1994b) The size of mortality differences associated with educational level in nine industrialized countries. Am J Public Health 84:932–937CrossRefGoogle Scholar
  20. 20.
    Kunst AE, Geurts JJM, van den Berg J (1995) International variation in socioeconomic inequalities in self reported health. J Epidemiol Community Health 49:117–123CrossRefGoogle Scholar
  21. 21.
    Kunst AE, Groenhof F, Mackenbach JP, EU Working Group on Socioeconomic Inequalities in Health (1998) Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. Br Med J 316:1636–1642CrossRefGoogle Scholar
  22. 22.
    Lampert T, Hoebel J, Kroll LE, Luy M (2018) Soziale Unterschiede in der Lebenserwartung. Public Health Forum 26:325–327CrossRefGoogle Scholar
  23. 23.
    Link BG, Phelan JC (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 35(Extra Issue):80–94CrossRefGoogle Scholar
  24. 24.
    Lorant V, de Gelder R, Kapadia D et al (2018) Socio-economic inequalities in suicide in Europe: the widening gap. Br J Psychiatry 212:356–361CrossRefGoogle Scholar
  25. 25.
    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 44:757–771CrossRefGoogle Scholar
  26. 26.
    Mackenbach JP, Kunst AE, Cavelaars AEJM et al (1997) Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet 349:1655–1659CrossRefGoogle Scholar
  27. 27.
    Mackenbach JP, Kunst AE, Groenhof F et al (1999) Socioeconomic inequalities in mortality among women and among men: an international study. Am J Public Health 89:1800–1806CrossRefGoogle Scholar
  28. 28.
    Mackenbach JP, Bos V, Andersen O et al (2003) Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 32:830–837CrossRefGoogle Scholar
  29. 29.
    Mackenbach JP, Stirbu I, Roskam AJR et al (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481CrossRefGoogle Scholar
  30. 30.
    Mackenbach JP (2011) Can we reduce health inequalities? An analysis of the English strategy (1997–2010). J Epidemiol Community Health 65:568–575CrossRefGoogle Scholar
  31. 31.
    Mackenbach JP, Kulhanova I, Bopp M et al (2015) Inequalities in alcohol-related mortality in 17 European countries: a retrospective analysis of mortality registers. PLoS Med 12(12):e1001909CrossRefGoogle Scholar
  32. 32.
    Mackenbach JP, Kulhanova I, Artnik B et al (2016) Changes in mortality inequalities over two decades: register based study of European countries. BMJ 353:i1732CrossRefGoogle Scholar
  33. 33.
    Mackenbach JP (2017a) Nordic paradox, Southern miracle, Eastern disaster: persistence of inequalities in mortality in Europe. Eur J Public Health 27(suppl. 4):14–17CrossRefGoogle Scholar
  34. 34.
    Mackenbach JP (2017b) Persistence of social inequalities in modern welfare states: explanation of a paradox. Scand J Public Health 45:113–120CrossRefGoogle Scholar
  35. 35.
    Mackenbach J, Bopp M, Deboosere P et al (2017) Determinants of the magnitude of socioeconomic inequalities in mortality: a study of 17 European countries. Health Place 47:44–53CrossRefGoogle Scholar
  36. 36.
    Mackenbach JP, Looman CWN, Artnik B et al (2017) “Fundamental causes” of inequalities in mortality: an empirical test of the theory in 20 European populations. Sociol Health Illn 39:1117–1133CrossRefGoogle Scholar
  37. 37.
    Mackenbach JP, Valverde JR, Artnik B et al (2018) Trends in health inequalities in 27 European countries. Proc Natl Acad Sci USA 115(25):6440–6445CrossRefGoogle Scholar
  38. 38.
    OECD (2011) Divided we stand: why inequality keeps rising. OECD, ParisCrossRefGoogle Scholar
  39. 39.
    OECD (2015) In it together: why less inequality benefits all. OECD, ParisCrossRefGoogle Scholar
  40. 40.
    Torssander J, Ahlbom A, Modig K (2016) Four decades of educational inequalities in hospitalization and mortality among older Swedes. PLoS ONE 11(3):e152369CrossRefGoogle Scholar
  41. 41.
    Torssander J, Moustgaard H, Peltonen R et al (2018) Partner resources and incidence and survival in two major causes of death. SSM Popul Health 4:271–279CrossRefGoogle Scholar
  42. 42.
    UN/WHO/CICRED Network (1984) Socio-economic differential mortality in industrialized societies no. 3. Paris: CICREDGoogle Scholar
  43. 43.
    UNESCO (1997) International standard classification of education—ISCED 1997. UNESCO, ParisGoogle Scholar
  44. 44.
    Vagerö D, Lundberg O (1989) Health inequalities in Britain and Sweden. Lancet 334:35–36CrossRefGoogle Scholar
  45. 45.
    Valkonen T (1989) Adult mortality and level of education: a comparison of six countries. In: Fox J (Hrsg) Health inequalities in European countries. Gower, Aldershot, Brookfield, Hong Kong, Singapore, Sydney, S 142–162Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Institut für Epidemiologie, Biostatistik und PräventionUniversität ZürichZürichSchweiz
  2. 2.Department of Public HealthErasmus University Medical Center RotterdamRotterdamNiederlande

Personalised recommendations