Socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s.
Studies on health inequalities have usually focused either on mortality or on morbidity. This concerns national studies as well as international comparisons of health inequalities. This paper seeks to bridge the gap by applying health expectancy as a synthetic overall measure of health. The purpose of the study is to compare socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s. Additionally, the major methodological issues in the use of health expectancy in the study of health inequalities are identified. Data on mortality by level of education derive from linked national follow-up studies (1986-1990) of population censuses. Data on the prevalence of morbidity by level of education derive from nationally representative surveys of the noninstitutionalised adult population in 1985/87. Persons aged 25-74 years were included. Four measures of morbidity were used: limiting long-standing illness, extremely limiting long-standing illness, functional disabilities and perceived less than good health. The association between mortality/morbidity and level of education in each 5-year age/sex group was determined by a regression-based method. Partial life expectancies and partial health expectancies for ages 25-74 were then calculated by using the mortality quotients and morbidity prevalences predicted by the regression model for those at the top and the bottom of the educational hierarchy in each 5-year age group, using an application of the method first presented by Sullivan. Although various measures of health expectancy were used, the result were consistent. In absolute terms the size of socioeconomic inequalities in health expectancy in Finland and Norway is on the same level. In relative terms, however, the size of inequalities in health expectancy is greater in Norway. If one considers premature mortality to be more severe than any indicator of morbidity, the mortality morbidity mix of the health inequalities is less favourable to Finland, since the size of absolute inequalities in mortality is greater in Finland. Health expectancy measures provide a promising measure for assessing and comparing the pattern and the size of health inequalities.
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
A P
AP
Sihvonen
A E
AE
Kunst
E
E
Lahelma
T
T
Valkonen
J P
JP
Mackenbach
D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D016018:Least-Squares Analysis; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D009664:Norway / Q000453:epidemiology; D012044:Regression Analysis; D012923:Social Class