Ivana Kulhánová1, Amaia Bacigalupe2, Terje A Eikemo1, Carme Borrell3, Enrique Regidor4, Santiago Esnaola5, Johan P Mackenbach6. 1. 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. 2. 2 Health Studies and Research Unit, Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain3 Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain. 3. 4 Agència de Salut Pública de Barcelona, Barcelona, Spain. 4. 5 Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain. 5. 2 Health Studies and Research Unit, Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain. 6. 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands j.mackenbach@erasmusmc.nl.
Abstract
BACKGROUND: While educational inequalities in mortality are substantial in most European countries, they are relatively small in Spain. A better understanding of the causes of these smaller inequalities in Spain may help to develop policies to reduce inequalities in mortality elsewhere. The aim of the present study was therefore to identify the specific causes of death and determinants contributing to these smaller inequalities. METHODS: Data on mortality by education were obtained from longitudinal mortality studies in three Spanish populations (Barcelona, Madrid, the Basque Country), and six other Western European populations. Data on determinants by education were obtained from health interview surveys. RESULTS: The Spanish populations have considerably smaller absolute inequalities in mortality than other Western European populations. This is due mainly to smaller inequalities in mortality from cardiovascular disease (men) and cancer (women). Inequalities in mortality from most other causes are not smaller in Spain than elsewhere. Spain also has smaller inequalities in smoking and sedentary lifestyle and this is due to more smoking and physical inactivity in higher educated groups. CONCLUSION: Overall, the situation with regard to health inequalities does not appear to be more favourable in Spain than in other Western European populations. Smaller inequalities in mortality from cardiovascular disease and cancer in Spain are likely to be related to its later socio-economic modernization. Although these smaller inequalities in mortality seem to be a historical coincidence rather than the outcome of deliberate policies, the Spanish example does suggest that large inequalities in total mortality are not inevitable.
BACKGROUND: While educational inequalities in mortality are substantial in most European countries, they are relatively small in Spain. A better understanding of the causes of these smaller inequalities in Spain may help to develop policies to reduce inequalities in mortality elsewhere. The aim of the present study was therefore to identify the specific causes of death and determinants contributing to these smaller inequalities. METHODS: Data on mortality by education were obtained from longitudinal mortality studies in three Spanish populations (Barcelona, Madrid, the Basque Country), and six other Western European populations. Data on determinants by education were obtained from health interview surveys. RESULTS: The Spanish populations have considerably smaller absolute inequalities in mortality than other Western European populations. This is due mainly to smaller inequalities in mortality from cardiovascular disease (men) and cancer (women). Inequalities in mortality from most other causes are not smaller in Spain than elsewhere. Spain also has smaller inequalities in smoking and sedentary lifestyle and this is due to more smoking and physical inactivity in higher educated groups. CONCLUSION: Overall, the situation with regard to health inequalities does not appear to be more favourable in Spain than in other Western European populations. Smaller inequalities in mortality from cardiovascular disease and cancer in Spain are likely to be related to its later socio-economic modernization. Although these smaller inequalities in mortality seem to be a historical coincidence rather than the outcome of deliberate policies, the Spanish example does suggest that large inequalities in total mortality are not inevitable.
Authors: Enrique Regidor; Laura Reques; María J Belza; Anton E Kunst; Johan P Mackenbach; Luis de la Fuente Journal: Int J Public Health Date: 2015-11-16 Impact factor: 3.380
Authors: Xavier Bartoll; Mercè Gotsens; Marc Marí-Dell'Olmo; Laia Palència; Montse Calvo; Santiago Esnaola; Carme Borrell Journal: Arch Public Health Date: 2019-03-15
Authors: Mariana Haeberer; Inmaculada León-Gómez; Beatriz Pérez-Gómez; María Téllez-Plaza; Mónica Pérez-Ríos; Anna Schiaffino; Fernando Rodríguez-Artalejo; Iñaki Galán Journal: PLoS One Date: 2020-09-28 Impact factor: 3.240