Educational inequalities in avoidable mortality in Europe.
BACKGROUND
The magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations was compared, and the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe was determined.


METHODS
Mortality data were obtained for people aged 30-64 years. For each country, the association between level of education and avoidable mortality was measured with the use of regression-based inequality indexes. Life table analysis was used to calculate the contribution of avoidable causes of death to inequalities in life expectancy between lower and higher educated groups.


RESULTS
Educational inequalities in avoidable mortality were present in all countries of Europe and in all types of avoidable causes of death. Especially large educational inequalities were found for infectious diseases and conditions that require acute care in all countries of Europe. Inequalities were larger in Central Eastern European (CEE) and Baltic countries, followed by Northern and Western European countries, and smallest in the Southern European regions. This geographic pattern was present in almost all types of avoidable causes of death. Avoidable mortality contributed between 11 and 24% to the inequalities in Partial Life Expectancy between higher and lower educated groups. Infectious diseases and cardiorespiratory conditions were the main contributors to this difference.


CONCLUSIONS
Inequalities in avoidable mortality were present in all European countries, but were especially pronounced in CEE and Baltic countries. These educational inequalities point to an important role for healthcare services in reducing inequalities in health.
Stirbu
Irina
I
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Kunst
Anton E
AE
Bopp
Matthias
M
Leinsalu
Mall
M
Regidor
Enrique
E
Esnaola
Santiago
S
Costa
Giuseppe
G
Martikainen
Pekka
P
Borrell
Carme
C
Deboosere
Patrik
P
Kalediene
Ramune
R
Rychtarikova
Jitka
J
Artnik
Barbara
B
Mackenbach
Johan P
JP
D002423:Cause of Death; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D012044:Regression Analysis; D012720:Severity of Illness Index; D012923:Social Class; D012959:Socioeconomic Factors