title: Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA.
abstract: Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Dr Molewaterplein 50, 3015 GE Rotterdam, Germany. r.hoffmann@erasmusmc.nl
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003431:Cross-Cultural Comparison; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011056:Political Systems / Q000145:classification; D012923:Social Class; D012946:Social Welfare; D014481:United States / Q000453:epidemiology