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Determinants of inequalities in life expectancy: an international comparative study of eight risk factors
University Medical Center Rotterdam, Rotterdam, Netherlands.
University Medical Center Rotterdam, Rotterdam, Netherlands.
University of Zürich, Zürich, Switzerland.
University of Copenhagen, Copenhagen, Denmark.ORCID iD: 0000-0003-3513-7245
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2019 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 4, no 10, p. E529-E537Article in journal (Refereed) Published
Abstract [en]

Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2.3-8.2 years among men and 0.6-4.5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19.8% among men and 18.9% among women), low income (9.7% and 13.4%), and high bodyweight (7.7% and 11.7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.

Place, publisher, year, edition, pages
The Lancet Publishing Group , 2019. Vol. 4, no 10, p. E529-E537
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Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:sh:diva-39269DOI: 10.1016/S2468-2667(19)30147-1ISI: 000488875200016PubMedID: 31578987Scopus ID: 2-s2.0-85072716131OAI: oai:DiVA.org:sh-39269DiVA, id: diva2:1366927
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-11-06Bibliographically approved

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1112131415161714 of 33
CiteExportLink to record
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Citation style
  • apa
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  • harvard-anglia-ruskin-university
  • apa-old-doi-prefix.csl
  • Other style
More styles
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