title: Obesity and the potential reduction of social inequalities in mortality: evidence from 21 European populations.
abstract: BACKGROUND
  Obesity contributes considerably to the problem of health inequalities in many countries, but quantitative estimates of this contribution and to what extent it is modifiable are scarce. We identify the potential for reducing educational inequalities in all-cause and obesity-related mortality in 21 European populations, by modifying educational differences in obesity and overweight.
  
  
  METHODS
  Prevalence data and mortality data come from 21 European populations. Mortality rate ratios come from literature reviews. We use the population attributable fraction (PAF) to estimate the impact of scenario-based changes in the social distribution of obesity on educational inequalities in mortality.
  
  
  RESULTS
  An elimination of differences in obesity between educational groups would decrease relative inequality in all-cause mortality between those with high and low education by up to 12% for men and 42% for women. About half of the relative inequality in mortality could be reduced for some causes of death in several countries, often in southern Europe. Absolute inequalities in all-cause mortality would be reduced by up to 69 (men) and 67 (women) deaths per 100,000 person-years.
  
  
  CONCLUSIONS
  The potential reduction of health inequality by an elimination of social inequalities in obesity might be substantial. The reductions differ by country, cause of death and gender, suggesting that the priority given to obesity as an entry-point for tackling health inequalities should differ between countries and gender.
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands r.hoffmann@erasmusmc.nl.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Terje A
authors.initials: TA
authors.lastname: Eikemo
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kulhánová
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Margarete C
authors.initials: MC
authors.lastname: Kulik
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.affiliation: 2 Department of Social Epidemiology, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France 3 Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: 4 Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.affiliation: 5 Department of Social Research, University of Helsinki, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: 6 Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012959:Socioeconomic Factors