title: The contribution of national disparities to international differences in mortality between the United States and 7 European countries.
abstract: OBJECTIVE
  This study examined to what extent the higher mortality in the United States compared to many European countries is explained by larger social disparities within the United States. We estimated the expected US mortality if educational disparities in the United States were similar to those in 7 European countries.
  
  
  METHODS
  Poisson models were used to quantify the association between education and mortality for men and women aged 30 to 74 years in the United States, Belgium, Denmark, Finland, France, Norway, Sweden, and Switzerland for the period 1989 to 2003. US data came from the National Health Interview Survey linked to the National Death Index and the European data came from censuses linked to national mortality registries.
  
  
  RESULTS
  If people in the United States had the same distribution of education as their European counterparts, the US mortality disadvantage would be larger. However, if educational disparities in mortality within the United States equaled those within Europe, mortality differences between the United States and Europe would be reduced by 20% to 100%.
  
  
  CONCLUSIONS
  Larger educational disparities in mortality in the United States than in Europe partly explain why US adults have higher mortality than their European counterparts. Policies to reduce mortality among the lower educated will be necessary to bridge the mortality gap between the United States and European countries.
authors.affiliation: Karen van Hedel, Frank J. van Lenthe, and Johan P. Mackenbach are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Mauricio Avendano is with the London School of Economics and Political Science, LSE Health and Social Care, London, UK, and the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA. Lisa F. Berkman is with the Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA. Matthias Bopp is with the Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland. Patrick Deboosere is with the Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium. Olle Lundberg is with the Center for Health Equity Studies, Stockholms Universitet Karolinska Institute, Stockholm, Sweden. Pekka Martikainen is with the Department of Sociology, University of Helsinki, Helsinki, Finland. Gwenn Menvielle is with the Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, and Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Karen
authors.initials: K
authors.lastname: van Hedel
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendano
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.forename: Olle
authors.initials: O
authors.lastname: Lundberg
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology