title: Changes in mortality inequalities over two decades: register based study of European countries.
abstract: OBJECTIVE
  To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.
  
  
  METHODS
  Register based study.
  
  
  METHODS
  Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively).
  
  
  METHODS
  All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania.
  
  
  RESULTS
  Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations.
  
  
  CONCLUSIONS
  Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.
authors.affiliation: Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands j.mackenbach@erasmusmc.nl.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.affiliation: Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kulhánová
authors.affiliation: Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Artnik
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
authors.affiliation: School of Geosciences, University of Edinburgh, Edinburgh.
authors.forename: Tom
authors.initials: T
authors.lastname: Clemens
authors.affiliation: Department of Clinical Medicine and Biology, University of Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.affiliation: School of Geosciences, University of Edinburgh, Edinburgh.
authors.forename: Chris
authors.initials: C
authors.lastname: Dibben
authors.affiliation: Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Ramune
authors.initials: R
authors.lastname: Kalediene
authors.affiliation: Center for Health Equity Studies, Stockholm, Sweden Department of Health Sciences, Mid Sweden University, Östersund.
authors.forename: Olle
authors.initials: O
authors.lastname: Lundberg
authors.affiliation: Department of Sociology, University of Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: Center for Health Equity Studies, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Östergren
authors.affiliation: Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Remigijus
authors.initials: R
authors.lastname: Prochorskas
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain.
authors.forename: Maica
authors.initials: M
authors.lastname: Rodríguez-Sanz
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Bjørn Heine
authors.initials: BH
authors.lastname: Strand
authors.affiliation: Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: de Gelder
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death / Q000639:trends*; D019352:Censuses; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors