scholarly journals Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015

2019 ◽  
Vol 34 (12) ◽  
pp. 1131-1142 ◽  
Author(s):  
Johan P. Mackenbach ◽  
José Rubio Valverde ◽  
Matthias Bopp ◽  
Henrik Brønnum-Hansen ◽  
Giuseppe Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Fixed Effects ◽  
Causes Of Death ◽  
Health Care Expenditure ◽  
European Countries ◽  
Mortality Data ◽  
Factors Associated ◽  
Country Level ◽  
Low Educated ◽  
Inequalities In Mortality

AbstractSocioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.

scholarly journals Smoking and Inequalities in Mortality in 11 European Countries: A Birth Cohort Analysis

2020 ◽  
Author(s):  
Di Long ◽  
Wilma Nusselder ◽  
Pekke Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Generations born during the twentieth century are at different stages of the smoking epidemic. Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

scholarly journals Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis

2021 ◽  
Author(s):  
Di Long ◽  
Johan Mackenbach ◽  
Pekka Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

scholarly journals Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Di Long ◽  
Johan Mackenbach ◽  
Pekka Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

Trends In Inequalities In Mortality Amenable To Health Care In 17 European Countries

2017 ◽  
Vol 36 (6) ◽  
pp. 1110-1118 ◽  
Author(s):  
Johan P. Mackenbach ◽  
Yannan Hu ◽  
Barbara Artnik ◽  
Matthias Bopp ◽  
Giuseppe Costa ◽  
...  
Keyword(s):  
Health Care ◽  
European Countries ◽  
Inequalities In Mortality

scholarly journals How can national governance affect education quality in Western Europe?

2020 ◽  
Vol 21 (3) ◽  
pp. 413-426 ◽  
Author(s):  
Ali Gerged ◽  
Mohamed Elheddad
Keyword(s):  
Fixed Effects ◽  
Western Europe ◽  
Resource Scarcity ◽  
The Body ◽  
European Countries ◽  
Education Quality ◽  
Educational Institutions ◽  
Content Type ◽  
Country Level ◽  
Western European

Purpose As the international society faces unprecedented challenges associated with resource scarcity, governance scandals, increasing injustice and inequality, new opportunities for higher education institutions are emerging. This paper aims to investigate the association between national governance standards and education quality across nine western European countries, namely, the UK, Germany, France, Finland, Norway, Switzerland, Sweden, Denmark and Ireland. Design/methodology/approach Using panel data from 2002 to 2017, this paper uses fixed-effects and random-effects models to examine the relationship between national governance (proxied by voice and accountability (V&A) indicator) and education quality (proxied by human development index: education index). This analysis is supplemented with conducting instrumental variable (IV) estimations to address any concerns regarding the expected occurrence of endogeneity problems. Findings The findings are suggestive of a significant and positive relationship between national governance and education quality in Europe. This implies that national governance standards, such as V&A, are essential actors in the enhancement of the quality of educational institutions’ outcomes. Research limitations/implications Policymakers should implement stricter regulations and ensure that accountability indicators are motivated if they wish to increase the spending on education, which is associated with better qualities of educational institutions. A culture of continuous review of education policies needs to be upheld in the Western Europe region to be watchful of any emerging problems while maintaining a sustainable relationship between the rule of law and the education administration. Originality/value So far, a minimal number of studies focussed on examining the role of country-level governance in advancing education quality. This study, therefore, extends the body of prior literature by investigating the possible effect of national governance structures on education quality across a sample of Western European countries.

scholarly journals Laboratory medicine in central and eastern Europe: Can we catch up?

2004 ◽  
Vol 23 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Gábor Kovács
Keyword(s):  
Health Care ◽  
Eastern Europe ◽  
Medical Training ◽  
Health Care Expenditure ◽  
Laboratory Medicine ◽  
European Countries ◽  
Medical Laboratories ◽  
Health And Disease ◽  
Catch Up ◽  
Central Eastern

Laboratory medicine, as defined by the IFCC and FESCC, is the application of chemical, molecular and cellular concepts and techniques to the understanding and evaluation of human health and disease. At the core of the discipline is the provision of results of measurements and observations relevant to the cause of disease, the maintenance of health and the conversion of these data into specific and general patient- and disease- related information at the laboratory-clinician interface. The discipline is committed to deepening the understanding of health and disease through fundamental and applied research. Furthermore, there are increasing health care expectations and consequently increasing demands of health care resources. Because of the increasing health costs, governments of many European countries have cut health care expenditure, often by decreasing the funding of acute care facilities, closing hospitals, outsourcing services or privatizing health care. Medical laboratories, highly dependent on rapidly changing, expensive and sophisticate technologies, have especially been affected by these policies. Several trends in medical laboratories are developing simultaneously: ? Centralization of diagnostic medical laboratories, rationalization of services, increased emphasis on cost-benefit analysis and cost-effective total patient care, linked to improving outcomes. ? Development of highly specialized laboratories at the interface with research. ? Implementation of point of care technology. ? Development of molecular biology procedures improving diagnosis of infections and inherited diseases. ? Computerization and telecommunication, which facilitates fast communication between laboratory and clinicians. ? Automation and robotics are changing the face of classic laboratories. ? A general trend towards accreditation or certification of laboratories in order to increase and recognize quality and excellence, including consultation services, pre -and post-analytical procedures. Medical laboratory specialists, whether of medical or non-medical training background, are responsible for comprehensive laboratory services including production of analytical results, consultation with clinicians, management, quality assurance, and computer technology. When possible, they conduct research and training in laboratory medicine. There are considerable differences among countries - in particular between highly developed countries of the European Union and countries of Central/Eastern Europe - in social, economical and health system developments, which affect the practice of medicine. The ultimate goal of laboratory specialists in the Central/Eastern European countries is to catch up with all these processes and also to reduce the gap between east and west in this respect. However, sufficient governmental financial resources are lacking as well. Thus, national laboratory societies bear a higher than ever responsibility in working out and implementing successful strategies, convincing public opinion, political opinion-leaders and the media about the importance of laboratory medicine, a discipline inevitable for successful predictive, preventive and clinical curative medicine.

scholarly journals A Bayesian hierarchical model with integrated covariate selection and misclassification matrices to estimate neonatal and child causes of death

2021 ◽  
Author(s):  
Amy R. Mulick ◽  
Shefali Oza ◽  
David Prieto-Merino ◽  
Francisco Villavicencio ◽  
Simon Cousens ◽  
...  
Keyword(s):  
Random Effects ◽  
Fixed Effects ◽  
Causes Of Death ◽  
National Level ◽  
Selection Procedure ◽  
Statistical Modelling ◽  
Model Parameters ◽  
Covariate Selection ◽  
Country Level ◽  
Nationally Representative

SummaryReducing neonatal and child mortality is a global priority. In countries without comprehensive vital registration data to inform policy and planning, statistical modelling is used to estimate the distribution of key causes of death. This modelling presents challenges given that the input data are few, noisy, often not nationally representative of the country from which they are derived, and often do not report separately on all of the key causes. As more nationally representative data come to be available, it becomes possible to produce country estimates that go beyond fixed-effects models with national-level covariates by incorporating country-level random effects. However, the existing frequentist multinomial model is limited by convergence problems when adding random effects, and had not incorporated a covariate selection procedure simultaneously over all causes. We report here on the translation of a fixed effects, frequentist model into a Bayesian framework to address these problems, incorporating a misclassification matrix with the potential to correct for mis-reported as well as unreported causes. We apply the new method and compare the model parameters and predicted distributions of eight key causes of death with those based on the previous, frequentist model.

scholarly journals Education-related inequalities in cause-specific mortality: First estimates for Australia using individual-level linked census and mortality data

2020 ◽  
Author(s):  
Jennifer Welsh ◽  
Grace Joshy ◽  
Lauren Morgan ◽  
Kay Soga ◽  
Hsei-Di Law ◽  
...  
Keyword(s):  
High Education ◽  
Causes Of Death ◽  
Negative Binomial ◽  
International Comparisons ◽  
Negative Binomial Regression ◽  
Medical Intervention ◽  
Mortality Data ◽  
Individual Level ◽  
Specific Mortality ◽  
Inequalities In Mortality

Background: Socioeconomic inequalities in mortality are evident in all high-income countries and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. Methods: Using Australian Census (2016) linked to 13-months of Death Registrations data (2016-17), we estimated relative rates (RR) and rate differences (RD, per100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high education (tertiary), for individual causes of death (among those 25-84y) and grouped according to preventability (25-74y), separately by sex and age group, adjusting for age, using negative binomial regression. Results: Among 13.9M people contributing 14 452 732 person-years, 84 743 deaths occurred. We observed inequalities in most causes of death for each age-sex group. Among men aged 25-44y, absolute and relative inequalities (low versus high education) were largest for injuries, e.g. transport accidents (RR=10.1 [95%CI: 5.4-18.7], RD=21.1 [15.9-26.3]). Among those aged 45-64y, inequalities were greatest for chronic diseases, e.g. lung cancer (men RR=6.6 [4.9-8.9], RD=55.6 [51.1-60.1]) and ischaemic heart disease (women RR=5.8 [3.7-9.1], RD=19.2 [17.0-21.5]), with similar patterns for people aged 65-84y. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. Conclusions: Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population.

Inequality in Infant Mortality Among Population of Modern Russia

2020 ◽  
Vol 27 (2) ◽  
pp. 48-62
Author(s):  
E. M. Andreev
Keyword(s):  
Health Care ◽  
Infant Mortality ◽  
Pregnant Women ◽  
Causes Of Death ◽  
Mortality Rates ◽  
European Countries ◽  
Infant Mortality Rate ◽  
Individual Factors ◽  
Official Statistics ◽  
Quality Health Care

Based on official statistics, the author tries to address the question of why the infant mortality rate in Russia is significantly higher than might be expected given the measures taken to protect the health of pregnant women and newborns. In the introduction, the author explains the relevance of studying inequality in the level of infant mortality among the population of modern Russia as a factor holding back the positive downward trend.After presenting the latest history of the evolution of the information and statistical base for population studies on the subjects under review, the author confirms the approach according to which it is advisable to work with data for real generations when analyzing the differentiation of infant mortality and generations born in 2014-2016 are chosen as the object of analysis.To determine the relevance of individual factors contributing to infant mortality, the author cross-tabulated raw data. Data on such initial characteristics (factors) as the birth order of the child, whether a mother is in a contracted civil marriage or not, mother’s level of education, were grouped by age groups of mothers. The use of cross-tabulation allowed to affirm not only the influence of individual factors on the level of infant mortality but also a quantitative differentiation between them. The article concludes the extent to which the overall level of infant mortality is determined by mortality rates from individual causes of death.A significant part of the article is presented in the format of author generalization using statistical methods regarding the educational differences of mothers, which have become differentiation factors in infant mortality rates.The socio-demographic analysis based on official statistics has confirmed not only some hypotheses as to why, despite the relatively rapid decrease in infant mortality in Russia in recent years, its level remains higher than in almost all European countries with reliable demographic statistics, but also to reveal the extent of the inequality of infant mortality in our country.The author argues that the reason why Russia lags behind many countries with the positive downward infant mortality trend is strongly associated with causes of death from conditions arising in the perinatal period as well as congenital disorders. This suggests that the level of medical care for pregnant women and newborns in Russia is still lower than in developed European countries. It also has to be assumed that different educational groups have unequal access to quality health care. А proactive approach to life as well as a progressive achievement of the right to choose a medical institution and a doctor - is one of the important directions for resolving a whole set of national health care issues.

On Health Expenditure and Income Inequality

2020 ◽  
pp. 117-151
Author(s):  
Orhan Torul
Keyword(s):  
Health Care ◽  
Income Inequality ◽  
Negative Correlation ◽  
Health Expenditure ◽  
Fixed Effects ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Significant Negative Correlation ◽  
Developed Economies ◽  
Using Data

This study investigates the relationship between health care expenditure and income inequality empirically. Using data from a large panel of countries covering a sizeable period of time, how level and composition of health care expenditures correlate with income inequality is studied via the panel data fixed effects estimation methodology. These estimations yield several robust findings. First, there is a significant positive correlation between income inequality and reliance on private resources for health care financing. Second, there exists a significant negative correlation between health care expenditure per capita and income inequality. Third, there is a significant negative correlation between income inequality and health care expenditure as a share of GDP. Next, this study analyzes a select group of well-established democracies with developed economies to detect if health expenditure and income inequality variables correlate with public beliefs and preferences. Empirical analyses reveal that indeed belief and preferences accord well with policy choices.

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