Hadewijch Vandenheede

Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16 812 men and 19 180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU.

Household-based socioeconomic position and diabetes-related mortality among married and cohabiting persons: findings from a census-based cohort study (Flanders, 2001–2010)

Background Diabetes prevalence is high worldwide, affecting entire populations. Yet some population groups are more susceptible than others. In contemporary western societies, socioeconomically disadvantaged groups are disproportionally affected. The pattern is less clear for diabetes mortality. Researchers argue increasingly in favour of looking beyond individual socioeconomic position (SEP). In light of the above, this paper looks at the relationship between individual-based and household-based SEP measures and diabetes mortality. Methods Data consisted of the Belgian 2001 census for the Flanders region linked to register data on cause-specific mortality during the period 2001–2010. The study population included all 35-year-old to 74-year-old official inhabitants of Flanders married or cohabiting at the 2001 census. Age-standardised death rates (direct standardisation) and mortality rate ratios (MRRs; Poisson regression) were computed for the different SEP groups. Results Inverse gradients were observed by own education, partners education and housing status (combination of housing tenure and quality). For example, among 55-year-olds to 74-year-olds, MRRs according to partners education were 3.0 (95% CI 2.4 to 3.8) for women with a lower-educated partner and 1.6 (95% CI 1.2 to 2.0) for women with a higher secondary-educated partner, relative to women with a higher-educated partner. As for housing status, diabetes-related mortality was particularly high among tenants and low-quality owners. The association between each of the SEP measures and diabetes-related mortality remained after adjusting for the other measures. Conclusions There were large differences in diabetes-related mortality according to both individual-based and household-based SEP measures, indicating the importance of the individual and household levels for understanding socioeconomic inequalities in diabetes mortality.

Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries

The article by Mackenbach et al 1 addresses educational inequalities in mortality at the turn of the 21st century by examining trends between the 1990s and the 2000s. Using harmonised data from official mortality registers, this study consists of a comprehensive mapping exercise: it includes 13 European countries, a breakdown of mortality into causes and it uses absolute as well as relative measures of inequality. Both absolute and relative measures are meaningful for monitoring health inequalities. While absolute measures may be more useful for public-health policy, relative measures are particularly apt for analytical purposes, especially when the overall mortality level is taken into account.2 By doing so, Mackenbach et al 1 draw a finely tuned picture of mortality inequalities in Europe that transcends ‘half-full/half-empty discussions’. Their encompassing account of mortality inequalities in Europe furthermore allows moving beyond mere description into the realm of explanations. Cross-country comparisons of mortality inequalities enable us to identify more distal determinants of inequalities, whereas the assessment of cause-specific mortality enables the identification of more proximal determinants. The study by Mackenbach et al 1 reveals that relative mortality inequalities remain stable at best and are actually widening in many European countries between the 1990s and the 2000s. Zooming in on absolute mortality inequalities, the picture looks …

Parental and/or Personal Socioeconomic Circumstances: How to Explain Site-Specific Cancer Mortality Inequalities Among Young Belgian Adults

Both socioeconomic position (SEP) in childhood and adulthood are associated with adult mortality. Yet, the relative importance of childhood socioeconomic (SE) conditions is likely to vary depending on the cause of death. This paper will study: 1) whether SE conditions during both childhood and adulthood are associated with overall and site-specific cancer mortality among Belgian young adults; 2) the relative importance of all indicators of parental and personal SEP in explaining differences in cancer mortality. Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and mortality follow-up data for 2001-2011. Parental educational attainment, parental occupational status, parental housing status, and childhood area deprivation were used as measures of parental SEP, and current education as indicator of personal SEP. SE differences were studied for overall and site-specific cancer mortality by calculating age-standardized mortality rates and mortality rate ratios using Poisson regression. Both low parental and personal SEP are associated with higher all-cancer mortality in young adulthood. Personal education seemed to be the strongest indicator of overall and site-specific cancer mortality in young adulthood, independent of parental SEP. Yet, for women, this was partly due to a health selection effect. In the full models, parental SEP was no longer associated with cancer mortality but deprived living conditions still were. Site-specific inequalities were generally more expressed among women than among men. Studies and policies focussing on SE inequalities in mortality in young adulthood should allow for both childhood and adulthood SE conditions.