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ABSTRACT: We examine the variations in the pace of old-age (80+) mortality decline in seven European countries, from 1950 to 1999. Marked
variations were found between countries, periods and sexes. While mortality declines were strong in France and England and
Wales, modest or no mortality declines were seen in the 1950s and 1960s in the Nordic countries, and since the 1980s in Denmark,
the Netherlands and Norway (men only). For non-smoking-related mortality, a high and consistent pace of mortality decline
was observed. Mortality decline stagnated among men born between 1890 and 1899, but persisted among women born between 1847
and 1937. The pace of old-age mortality decline correlated with the pace of mortality decline at ages 60–69 among the same
cohorts, but only among men and not for non-smoking-related mortality. Smoking, thus, seems more important than other factors
originating earlier in life. Our results furthermore indicate substantial future declines in old-age mortality.
Nous examinons les variations dans la baisse de la mortalité aux âges élevés (80 ans et plus) dans sept pays européens, de
1950 à 1999. Des variations marquées sont observées entre les pays, entre les périodes et entre les sexes. Alors que la baisse
était forte en France et en Angleterre et pays de Galles, elle était modeste ou non existante dans les années 50 et 60 dans
les pays du Nord de l’Europe, et depuis les années 80 au Danemark, aux Pays-Bas et en Norvège (pour les hommes seulement).
Pour la mortalité non liée au tabac, un rythme soutenu et régulier de baisse de la mortalité est observé. La baisse a subi
une stagnation parmi les hommes nés entre 1890 et 1899, mais s’est maintenue parmi les femmes nées entre 1847 et 1937. Le
rythme de baisse de la mortalité aux âges élevés était corrélé au rythme de baisse à 60–69 ans dans les mêmes cohortes, mais
seulement parmi les hommes et pas pour la mortalité non liée au tabac. Le tabac semble donc jouer un rôle plus important que
d’autres facteurs intervenant plus tôt dans la vie. Nos résultats permettent d’anticiper des baisses substantielles de la
mortalité aux âges élevés dans le futur.
European Journal of Population 04/2012; 23(2):171-188. · 1.75 Impact Factor
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Silke Hermann,
Sabine Rohrmann,
Jakob Linseisen,
Anne M May, Anton Kunst,
Herve Besson,
Dora Romaguera,
Noemie Travier,
Maria-Jose Tormo,
Esther Molina, [......],
Jonas Manjer,
Tonje Braaten,
Guy Fagherazzi,
Françoise Clavel-Chapelon,
Traci Mouw,
Teresa Norat,
Elio Riboli,
Sabina Rinaldi,
Nadia Slimani,
Petra H M Peeters
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ABSTRACT: To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).
This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.
Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.
In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.
BMC Public Health 03/2011; 11:169. · 2.00 Impact Factor
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ABSTRACT: Lower social class has higher lung cancer incidence, largely attributable to higher smoking prevalence among the lower social classes. We assessed the magnitude and time dimension of potential impact of targeted interventions on smoking on socioeconomic inequalities in lung cancer.
Using population dynamic modelling, we projected lung cancer incidence up to 2050 in lowest and highest socioeconomic groups under two intervention scenarios (annual 10% increase in cigarette prices and health advertisement) and compared this to a scenario of no intervention. For the analysis we retrieved smoking prevalence data from the General Household Survey of England and Wales between 1980 and 2006 and cancer incidence data from the national cancer registry.
By 2050, the model projected that lung cancer incidence inequality would almost double (Incidence Rate Ratio (IRR)=4.2 in 2050 vs. 2.5 in 2005) in men and slightly decrease (IRR=2.4 in 2050 vs. 2.7 in 2005) in women compared to what was observed in 2005. If annual increase in cigarette price targeting the lowest socioeconomic group was implemented, socioeconomic inequality in lung cancer incidence in 2050 might be largely reduced (IRR=1.5 and 1.4 among men and women, respectively). If in addition to annual price increase (targeted to the lowest socioeconomic group) health advertisement was implemented and successfully reduced smoking prevalence in the highest socioeconomic group, the lung cancer gap between the socioeconomic groups would be reduced by 78% and 58% in men and women by 2050.
Even under the best scenarios, inequality in lung cancer was not fully eliminated within 45 years period. Though the process is lengthy, rigorous interventions may reduce the expected widening of the future inequalities in lung cancer. Modelling exercise such as ours relies heavily on the quality of the input data and the assumptions, thus caution is needed in interpretation of our findings and should consider all the assumptions taken in the analysis.
Lung cancer (Amsterdam, Netherlands) 02/2011; 73(3):268-73. · 3.14 Impact Factor
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ABSTRACT: Abstract Background In developed European countries in the last phase of the smoking epidemic, education is a stronger predictor of smoking than income or employment. We examine whether this also applies in economically less developed countries. Methods Data from 7218 respondents in the 25-64 age group came from two National Health Interview Surveys conducted in 2000 and 2003 in Hungary. Independent effects of educational level, income and employment status were studied in relation to smoking prevalence, initiation and continuation for all age groups combined and separately for 25-34, 35-49 and 50-64 years old. Absolute levels were evaluated by using age-standardized prevalence rates. Relative differences were assessed by means of logistic regression. Results Education and income, but not employment, were associated with equally large differences in smoking prevalence in Hungary in the 25-64 age group. Among men, smoking initiation was related to low educational level, whereas smoking continuation was related to low income. Among women, low education and low income were associated with both high initiation and high continuation rates. Considerable differences were found between the age groups. Inverse social gradients were generally strongest in the youngest age groups. However, smoking continuation among men had the strongest association with low income for the middle-aged group. Conclusions Patterns of inequalities in smoking in Hungary can be best understood in relation to two processes: the smoking epidemic, and the additional effects of poverty. Equity orientated tobacco control measures should target the low educated to prevent their smoking initiation, and the poor to improve their cessation rates.
BMC Public Health. 01/2011;
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ABSTRACT: To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups.
We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations.
The available evidence supports the hypothesis that while organized population screening programs are successful in increasing overall participation rates, they may not per se substantially reduce social inequalities. Some strategies were consistently found to enhance access to screening among lower socioeconomic groups, including cost-reducing interventions (e.g. offering free tests and eliminating geographical barriers), a greater involvement of primary-care physicians and individually tailored pro-active communication that addresses barriers to screening.
Evidence from studies suggests that the attendance of deprived women to cancer screening can be improved with organized screening programs tailored to their needs. The same may apply to the prevention of adverse outcomes of other health conditions, such as hypertension, hypercholesterolemia, and diabetes.
Preventive Medicine 04/2010; 50(4):159-64. · 3.22 Impact Factor
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ABSTRACT: To determine the magnitude of social inequalities in cancer incidence according to different socioeconomic indicators and to assess the independent role of each indicator.
Data from the Turin Longitudinal Study and the Piedmont Cancer Registry (1985-1999) were used to analyse the relationship of cancer incidence with three dimensions of individual socioeconomic position (education, occupation, and material living conditions) and with an area-based deprivation index. Multivariate Poisson regression models were used to estimate both relative risks and relative indexes of inequality (RIIs).
Results showed an independent role of all the socioeconomic indicators. The overall gradients of inequalities, expressed by the RIIs for total cancer incidence, varied from 9 to 26% among men; among women, we estimated a 22% protection at the bottom of the educational hierarchy, and a 12% gradient for decreasing ease of living conditions. For most cancer sites, socioeconomic position in early adult life was as important as later socioeconomic position, while the area-based deprivation index played only an additional role.
Different socioeconomic indicators pinpoint to a series of specific risk factors that are related to specific phases of the life course. Individual level data, rather than ecological data, is preferred to accurately monitor social inequalities in cancer risk.
Cancer Causes and Control 03/2010; 21(7):1117-30. · 2.88 Impact Factor
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ABSTRACT: In Spain, despite the existence of a National Health System (NHS), the utilization of some curative health services is related to social class. This study assesses (1) whether these inequalities are also observed for preventive health services and (2) the role of additional private health insurance for people of advantaged social classes. Using data from the Spanish National Health Survey of 2006, the authors analyze the relationships between social class and use of health services by means of Poisson regression models with robust variance, controlling for self-assessed health. Similar analyses were performed for waiting times for visits to a general practitioner (GP) and specialist. After controlling for self-perceived health, men and women from social classes IV-V had a higher probability of visiting the GP than other social classes, but a lower probability of visiting a specialist or dentist. No large class differences were observed in frequency of hospitalization or emergency services use, or in breast cancer screening or influenza vaccination; cervical cancer screening frequency was lower among women from social classes IV-V. The inequalities in specialist visits, dentist visits, and cervical cancer screening were larger among people with only NHS insurance than those with double health insurance. Social class differences in waiting times were observed for specialist visits, but not for GP visits. Men and women from social classes IV-V had longer waits for a specialist; this was most marked among people with only NHS insurance. Clearly, within the NHS, social class inequalities are still evident for some curative and preventive services. Further research is needed to identify the factors driving these inequalities and to tackle these factors from within the NHS. Priority areas include specialist services, dental care, and cervical cancer screening.
International Journal of Health Services 01/2010; 40(3):525-42. · 1.21 Impact Factor
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ABSTRACT: The aim of the study is to evaluate whether health inequalities associated with unemployment are comparable across different ethnic groups.
A random sample of inhabitants of the city of Rotterdam filled out a questionnaire on health and its determinants, with a response of 55.4% (n = 2,057). In a cross-sectional design the associations of unemployment, ethnicity, and individual characteristics with a perceived poor health were investigated with logistic regression analysis. The associations of these determinants with physical and mental health, measured by the Short Form 36 Health Survey, were evaluated with linear regression analyses. Interactions between ethnicity and unemployment were investigated to determine whether associations of unemployment and health differed across ethnic groups.
Ill health was more common among unemployed persons [odds ratio (OR) 2.6; 95% CI 1.7-3.8] than workers in paid employment. Health inequalities between employed and unemployed persons were largest among native Dutch persons (OR = 3.2) and Surinamese/Antillean persons (OR = 2.6), and smaller in Turkish/Moroccan persons (OR = 1.6) and overseas refugees (OR = 1.6). The proportions of persons with poor health that could be attributed to unemployment were 14, 26, 14, and 13%, respectively.
Differences in ill health between employed and unemployed persons were less profound in ethnic groups compared to the majority population, but the prevalence of unemployment was much higher in ethnic groups. The population attributable fractions varied between 14 and 28%, supporting the argument that policies for health equity should pay more attention to measures that include persons in the labour market and that prevent workers with ill health from dropping out of the workforce.
International Archives of Occupational and Environmental Health 03/2009; 82(8):1023-30. · 1.89 Impact Factor
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Carme Borrell,
Albert Espelt,
Maica Rodríguez-Sanz,
Bo Burström,
Carles Muntaner,
M Isabel Pasarín,
Joan Benach,
Chiara Marinacci,
Albert-Jan Roskam,
Maartje Schaap,
Enrique Regidor,
Giuseppe Costa,
Paula Santana,
Patrick Deboosere, Anton Kunst,
Vicente Navarro
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ABSTRACT: The objectives of this study are to describe, for European countries, variations among political traditions in the magnitude of inequalities in self-perceived health by educational level and to determine whether these variations change when contextual welfare state, labor market, wealth, and income inequality variables are taken into account. In this cross-sectional study, the authors look at the population aged 25 to 64 in 13 European countries. Individual data were obtained from the Health Interview Surveys of each country. Educational-level inequalities in self-perceived health exist in all countries and in all political traditions, among both women and men. When countries are grouped by political tradition, social democratic countries are found to have the lowest educational-level inequalities.
International Journal of Health Services 02/2009; 39(2):321-41. · 1.21 Impact Factor
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ABSTRACT: Abstract
Background
Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups.
Methods
The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses.
Results
The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08–3.63) as high as in the highest income quintile.
Conclusion
Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.
BMC Health Services Research. 01/2009;
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ABSTRACT: Abstract
Background
Higher prevalence rates of unhealthy behaviours among lower socioeconomic groups contribute substantially to socioeconomic inequalities in health in adults. Preventing the development of these inequalities in unhealthy behaviours early in life is an important strategy to tackle socioeconomic inequalities in health. Little is known however, about health promotion strategies particularly effective in lower socioeconomic groups in youth. It is the purpose of project TEENAGE to improve knowledge on the prevention of socioeconomic inequalities in physical activity, diet, smoking and alcohol consumption among adolescents in Europe. This paper describes the background, design and methods to be used in the project.
Methods/design
Through a systematic literature search, existing interventions aimed at promoting physical activity, a healthy diet, preventing the uptake of smoking or alcohol, and evaluated in the general adolescent population in Europe will be identified. Studies in which indicators of socioeconomic position are included will be reanalysed by socioeconomic position. Results of such stratified analyses will be summarised by type of behaviour, across behaviours by type of intervention (health education, environmental interventions and policies) and by setting (individual, household, school, and neighbourhood). In addition, the degree to which effective interventions can be transferred to other European countries will be assessed.
Discussion
Although it is sometimes assumed that some health promotion strategies may be particularly effective in higher socioeconomic groups, thereby increasing socioeconomic inequalities in health-related behaviour, there is little knowledge about differential effects of health promotion across socioeconomic groups. Synthesizing stratified analyses of a number of interventions conducted in the general adolescent population may offer an efficient guidance for the development of strategies and interventions to prevent socioeconomic inequalities in health early in life.
BMC Public Health 01/2009; · 2.00 Impact Factor
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European journal of cancer (Oxford, England: 1990) 10/2008; 44(14):1933-7. · 4.12 Impact Factor
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ABSTRACT: To compare educational inequalities in cancer mortality between Poland, Lithuania, Estonia, Finland and Sweden.
Data are either follow-up or unlinked cross-sectional studies. The relative index of inequality (RII) and the slope index of inequality (SII) are calculated to express the magnitude of mortality differences according to educational level for all cancers and for specific cancers.
Large educational inequalities in total cancer mortality were observed, particularly amongst men. Inequalities in upper aero-digestive tract and lung cancer in men and cervix cancer in women were larger in Poland, Lithuania and Estonia, whereas inequalities in lung cancer in women were larger in Finland and Sweden.
Countries of the Baltic Sea region differ strongly with regard to the magnitude and pattern of the educational inequalities in cancer mortality.
European Journal of Cancer 03/2008; 44(3):454-64. · 5.54 Impact Factor
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ABSTRACT: Incomplete immunization coverage is common in low-income families and Aboriginal children in Canada.
To determine whether child immunization coverage rates at two years of age were lower in low-income neighbourhoods of Saskatoon, Saskatchewan.
Parents who were and were not behind in child immunization coverage were contacted to determine differences in knowledge, beliefs and opinions on barriers and solutions. A multivariate regression model was designed to determine whether Aboriginal cultural status was associated with being behind in childhood immunizations after controlling for low-income status.
Reviewing the past five years in Saskatoon, the six low-income neighbourhoods had complete child immunization coverage rates of 43.7% (95% CI 41.2 to 45.9) for measles-mumps-rubella, and 42.6% (95% CI 40.1 to 45.1) for diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type B. The five affluent neighbourhoods had 90.6% (95% CI 88.9 to 92.3) immunization coverage rates for measles-mumps-rubella, and 78.6% (95% CI 76.2 to 81.0) for diphtheria, pertussis, tetanus, polio and H influenzae type B. Parents who were behind in immunization coverage for their children were more likely to be single, of Aboriginal or other (non-Caucasian or non-Aboriginal) cultural status, have lower family income and have significant differences in reported beliefs, barriers and potential solutions. In the final regression model, Aboriginal cultural status was no longer associated with lower immunization status.
Child immunization coverage rates in Saskatoon's six low-income neighbourhoods were approximately one-half the rate of the affluent neighbourhoods. The covariates with the strongest independent association with complete childhood immunization status were low income and other cultural status. Aboriginal cultural status was not associated with low child immunization rates after controlling for income status.
Paediatrics & child health 01/2008; 12(10):847-52. · 0.78 Impact Factor
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ABSTRACT: To examine the effects of ill health on selection into paid employment in European countries.
Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis.
An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level.
In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.
Journal of Epidemiology & Community Health 08/2007; 61(7):597-604. · 3.19 Impact Factor
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Bjørn Heine Strand, Anton Kunst,
Martijn Huisman,
Gwenn Menvielle,
Myer Glickman,
Matthias Bopp,
Carme Borell,
Jens Kristian Borgan,
Giuseppe Costa,
Patrick Deboosere,
Enrique Regidor,
Tapani Valkonen,
Johan P Mackenbach
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ABSTRACT: Higher socioeconomic position has been reported to be associated with increased risk of breast cancer mortality. Our aim was to see if this is consistently observed within 11 European populations in the 1990s. Longitudinal data on breast cancer mortality by educational level and marital status were obtained for Finland, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Austria, Turin, Barcelona and Madrid. The relationship between breast cancer mortality and education was summarised by means of the relative index of inequality. A positive association was found in all populations, except for Finland, France and Barcelona. Overall, women with a higher educational level had approximately 15% greater risk of dying from breast cancer than those with lower education. This was observed both among never- and ever-married women. The greater risk of breast cancer mortality among women with a higher level of education was a persistent and generalised phenomenon in Europe in the 1990s.
European Journal of Cancer 06/2007; 43(7):1200-7. · 5.54 Impact Factor
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ABSTRACT: There is growing evidence that childhood socioeconomic position (SEP) influences adult health. The authors' aim was to describe the association between childhood SEP measures (parents' education, occupation, and income) and mortality, for both genders, and to assess to what extent this association was mediated by adult SEP. Registry data for all Norwegians born in 1955-1965 were used. Death records were linked to the cohort, and 6,589 persons died during 1990-2001. Cox's regression was used to calculate relative rates and the relative index of inequality. Low childhood SEP was associated with increased mortality for most causes of death, except for breast cancer, where no association was found. For suicide in women, low childhood SEP was protective. Adult SEP accounted for the associations for total mortality and most causes of death. However, adult SEP accounted for only one half of the association of father's educational level with ischemic heart disease mortality among men. The increased suicide risk among women with high childhood SEP persisted, regardless of adult SEP. In summary, childhood SEP had a direct association with early adult cardiovascular mortality in men and with suicide in women. For other causes of death, childhood SEP was only indirectly associated, mostly through persons' own educational level.
American Journal of Epidemiology 02/2007; 165(1):85-93. · 5.22 Impact Factor
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ABSTRACT: Even though the causes of suicide may be rooted in childhood, it is unknown how socioeconomic position (SEP) in childhood is related to suicide in adulthood. We describe the association between childhood SEP and suicide mortality in adulthood in Norway using registry data on 613807 Norwegians born in 1955-1965. Data on 1013 suicide deaths between 1990 and 2001 were linked to data on SEP indicators, using Cox regression. Suicide mortality was higher among women with high childhood SEP than among women with low childhood SEP. This association was explained in part by family situation in adulthood, but not by adult SEP. For males, after adjustment for adult SEP, we observed a similar but weaker association between suicide and childhood SEP. We discuss several mechanisms which may explain the direct positive association of childhood SEP with suicide mortality in adulthood, especially among females. These are downward mobility, not meeting high demands set by highly educated parents, psychological distress, mental disorder, gender differences and social networks and norms.
Social Science [?] Medicine 01/2007; 63(11):2825-34. · 2.70 Impact Factor
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ABSTRACT: To analyze the pattern in the incidence of quitting smoking in Spain from 1965 to 2000 according to gender, age and educational level.
We used data from 5 Spanish National Health Interview Surveys including 33532 ever smokers>or=20 years old. We reconstructed the history of smoking and the age at smoking cessation. We calculated the biannual incidence of quitting smoking according to sex, age and educational level. We fitted joinpoint regression to identify significant changes in trends.
The incidence of quitting smoking at ages 20-50 years has increased from 0.5% in 1965-1966 to 4.9% in 1999-2000 for males and from 1.1% in 1965-1966 to 5.0% in 1999-2000 in females. For those aged>50 years old, the incidence of quitting smoking has increased from 0.4% in 1965-1966 to 8.7% in 1999-2000 for males and from 7.9% in 1973-1974 to 8.8% in 1999-2000 in females. A level-off in cessation rates is observed both in men and women aged 20-50 years old with lower educational level in the last decade, while cessation among those with higher educational level continue to increase.
The different pattern of smoking cessation according to gender, age, and level of education suggests that health promotion actions and tobacco control policies might have had a different effect among different population subgroups.
Preventive Medicine 01/2007; 45(2-3):226-32. · 3.22 Impact Factor
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ABSTRACT: Abstract
Background
As reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries.
Methods
Wealth-group specific data on under-5 mortality, immunisation coverage, antenatal and delivery care for 43 countries were obtained from the Demographic and Health Surveys. These data were used to describe the association between the overall level of these outcomes on the one hand, and relative and absolute poor-rich inequalities in these outcomes on the other.
Results
We demonstrate that the values that the absolute and relative inequality measures can take are bound by mathematical ceilings. Yet, even where these ceilings do not play a role, the magnitude of inequality is correlated with the overall level of the outcome. The observed tendencies are, however, not necessities. There are countries with low mortality levels and low relative inequalities. Also absolute inequalities showed variation at most overall levels.
Conclusion
Our study shows that both absolute and relative inequality measures can be meaningful for monitoring inequalities, provided that the overall level of the outcome is taken into account. Suggestions are given on how to do this. In addition, our paper presents data that can be used for benchmarking of inequalities in the field of maternal and child health in low and middle-income countries.
International Journal for Equity in Health. 01/2007;
