Trends in health inequalities in 27 European countries
Trends in health inequalities in 27 European countries
复制标题
DOI：
10.1073/pnas.1800028115
复制
发表时间：
2018-06-19
影响因子：
11.1
通讯作者：
Nusselder, Wilma J.
中科院分区：
文献类型：
--
作者：
Mackenbach, Johan P.;Valverde, Jose Rubio;Nusselder, Wilma J.
美国最近报道了受教育程度低的人的不利健康趋势。我们分析了欧洲国家教育的健康趋势，特别注意最近趋势中断的可能性，包括与2008年金融危机影响有关的中断。我们收集并整理了癌症死亡率的数据。1980年，任。2014年17个国家的980万例死亡和自报发病率数据。2002年，任。2014年，27个国家的350，000名调查受访者。我们使用中断的时间序列分析来研究随着时间的推移和国家固定效应分析的变化，以研究危机相关的经济条件对健康结果的影响。最近的趋势比前几十年更有利，特别是在东欧，受教育程度低的男性死亡率开始下降，自我评估健康状况不佳的下降速度加快，导致健康不平等现象有所缩小。在西欧，受教育程度低和高的人的死亡率继续下降，虽然在受金融危机严重打击的国家，自我评估健康状况不佳的下降速度有所减缓，但受教育程度低和高的人受到的影响是一样的。与危机有关的经济状况与健康不平等的扩大无关。我们的研究结果表明，在美国观察到的不利趋势在欧洲没有发现。危机对人口一级的保健不平等也没有明显的短期影响。这两项研究结果都表明，欧洲国家成功地避免了健康不平等的加剧。
Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and 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. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable 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. Our results show that the unfavorable 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. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.