IJE Advance Access originally published online on November 24, 2004
International Journal of Epidemiology 2005 34(2):295-305; doi:10.1093/ije/dyh342
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Trends in socioeconomic inequalities in self-assessed health in 10 European countries
1 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
2 Department of Public Health, University of Helsinki, Helsinki, Finland
3 Department of Epidemiology and Public Health, University College, London, United Kingdom
4 National Institute of Public Health, Copenhagen, Denmark
5 Department of Epidemiology, Ministry of Health, Madrid, Spain
6 GSF Institute of Health Economics and Health Care Management, Neuherberg, Germany
7 Department of Social Research, University of Piemonte Orientale, Allessandria, Italy
8 Division KPE, Statistics Netherlands, Heerlen, The Netherlands
9 Centre for Social Policy Research, University of Bremen, Bremen, Germany
10 Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
11 Health Division, Statistics Norway, Oslo, Norway
12 Department of Public Health and Microbiology, Turin University, Turin, Italy
13 Institute of Social Medicine and Epidemiology, University of Graz, Graz, Austria
* Corresponding author. Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: a.kunst{at}erasmusmc.nl
Background Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries.
Methods Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than ‘good’ was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs).
Results Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase.
Conclusions The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.
Keywords Educational level, poverty, income, socioeconomic status, socioeconomic factors, inequalities, self-assessed health, health surveys, trends, international perspectives, European Union
Accepted 24 August 2004
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