Investigating explanations of socio-economic inequalities in health: the Dutch GLOBE study.
BACKGROUND
The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described.


METHODS
The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15-74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death.


RESULTS
Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation.


CONCLUSIONS
The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands.
van Lenthe
Frank J
FJ
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. f.vanlenthe@erasmusmc.nl
Schrijvers
Carola T M
CT
Droomers
Mariel
M
Joung
Inez M A
IM
Louwman
Marieke J
MJ
Mackenbach
Johan P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006291:Health Policy; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009426:Netherlands; D012923:Social Class; D012935:Social Justice