Emmanuelle Cambois

Institut national d'études démographiques, Lutetia Parisorum, Île-de-France, France

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Publications (70)117.11 Total impact

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    ABSTRACT: Background: Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes. Methods: Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups. Results: The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups. Conclusions: The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.
    No preview · Article · Nov 2015 · Journal of epidemiology and community health
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    ABSTRACT: The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010. HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately. Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010. Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
    Full-text · Article · Apr 2015 · The European Journal of Public Health
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    ABSTRACT: The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population. Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries. When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question. The study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another.
    Full-text · Article · Jan 2015 · BMC Medical Research Methodology
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    ABSTRACT: Background Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess the effect of smoking on the average years lived without disability (Disability Free Life Expectancy (DFLE)) and with disability (Disability Life Expectancy (DLE)) and (2) to estimate the extent to which these effects are due to better survival or reduced disability in never smokers. Methods Data on disability and mortality were provided by the Belgian Health Interview Survey 1997 and 2001 and a 10 years mortality follow-up of the survey participants. Disability was defined as difficulties in activities of daily living (ADL), in mobility, in continence or in sensory (vision, hearing) functions. Poisson and multinomial logistic regression models were fitted to estimate the probabilities of death and the prevalence of disability by age, gender and smoking status adjusted for socioeconomic position. The Sullivan method was used to estimate DFLE and DLE at age 30. The contribution of mortality and of disability to smoking related differences in DFLE and DLE was assessed using decomposition methods. Results Compared to never smokers, ex-smokers have a shorter life expectancy (LE) and DFLE but the number of years lived with disability is somewhat larger. For both sexes, the higher disability prevalence is the main contributing factor to the difference in DFLE and DLE. Smokers have a shorter LE, DFLE and DLE compared to never smokers. Both higher mortality and higher disability prevalence contribute to the difference in DFLE, but mortality is more important among males. Although both male and female smokers experience higher disability prevalence, their higher mortality outweighs their disability disadvantage resulting in a shorter DLE. Conclusion Smoking kills and shortens both life without and life with disability. Smoking related disability can however not be ignored, given its contribution to the excess years with disability especially in younger age groups.
    Full-text · Article · Jul 2014 · BMC Public Health
  • Armelle Andro · Emmanuelle Cambois · Marie Lesclingand
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    ABSTRACT: Female genital mutilation (FGM) concerns an estimated half a million women in Europe. The studies based in countries where migrant women have settled highlight the need for more accurate information on FGM health consequences, in a European health care context. Excision and Handicap (ExH) is a multi-centric survey based on case-control methodology and conducted in France to assess the long-term consequences of FGM, sampling both FGM and non-FGM adult women. The interviews were conducted in 74 mother-and-child health centres and hospital departments providing gynaecological and family planning services in five French regions. The two groups were compared on health indicators (self-perceived health, illnesses, symptoms) and functioning indicators (daily, sexual and reproductive life) for cases (n = 678) and controls (n = 1706). Multivariate logistic models highlighted FGM-related health problems. Among women living in France, FGM was significantly associated with poor health indicators: gynaecological and urinary infections (OR = 2.0), sleep disorders (OR = 1.4), intense pain (OR = 1.5), difficulties in daily life (OR = 1.5) and in sexual life (OR = 1.7) or tearing during childbirth (OR = 1.6). Our results suggest that, even in a favourable healthcare context, FGM exposes women to long-term health problems, including in areas neglected in previous research. They confirm the need to establish recommendations to help physicians understand these women's needs.
    No preview · Article · Feb 2014 · Social Science [?] Medicine
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    J.-M. Robine · E. Cambois
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    ABSTRACT: Each year since 2005, Eurostat has calculated life expectancy without activity limitations, known as "healthy life years". While life expectancy at age 65 increased by one year in the European Union between 2005 and 2010, the years lived in poor perceived health decreased (by 0.5 years for men and 1.1 years for women) despite an increase in years with chronic morbidity (1.6 years for men, 1.3 years for women). Years without limitation of activity remained unchanged. This paradox can be explained in part by more systematic detection and improved management of health problems, whose prevalence may thus increase without necessarily producing an increase in reported activity limitations or in negative perceptions of health.
    Full-text · Article · Apr 2013
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    ABSTRACT: Background: The European Innovation Partnership on Active and Healthy Ageing seeks an increase of two healthy life years (HLY) at birth in the EU27 for the next 10 years. We assess the feasibility of doing so between 2010 and 2020 and the differential impact among countries by applying different scenarios to current trends in HLY. Methods: Data comprised HLY and life expectancy (LE) at birth 2004-09 from Eurostat. We estimated HLY in 2010 in each country by multiplying the Eurostat projections of LE in 2010 by the ratio HLY/LE obtained either from country and sex-specific linear regression models of HLY/LE on year (seven countries retaining same HLY question) or extrapolating the average of HLY/LE in 2008 and 2009 to 2010 (20 countries and EU27). The first scenario continued these trends with three other scenarios exploring different HLY gap reductions between 2010 and 2020. Results: The estimated gap in HLY in 2010 was 17.5 years (men) and 18.9 years (women). Assuming current trends continue, EU27 HLY increased by 1.4 years (men) and 0.9 years (women), below the European Innovation Partnership on Active and Healthy Ageing target, with the HLY gap between countries increasing to 18.3 years (men) and 19.5 years (women). To eliminate the HLY gap in 20 years, the EU27 must gain 4.4 HLY (men) and 4.8 HLY (women) in the next decade, which, for some countries, is substantially more than what the current trends suggest. Conclusion: Global targets for HLY move attention from inter-country differences and, alongside the current economic crisis, may contribute to increase health inequalities.
    Full-text · Article · Mar 2013 · The European Journal of Public Health
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    ABSTRACT: Background Life expectancy has been increasing during the last century within the European Union (EU). To measure progress in population health it is no longer sufficient to focus on the duration of life but quality of life should be considered. Healthy Life Years (HLY) allow estimating the quality of the remaining years that a person is expected to live, in terms of being free of long-standing activity limitation. The Joint Action on Healthy Life Years (JA: EHLEIS) is a joint action of European Member States (MS) and the European Union aiming at analysing trends, patterns and differences in HLY, as well as in other Summary Measures of Population Health (SMPH) indicators, across the European member states. Methods The JA: EHLEIS consolidates existing information on life and health expectancy by maximising the European comparability; by analysing trends in HLY within the EU; by analysing the evolution of the differences in HLY between Member States; and by identifying both macro-level as micro-level determinants of the inequalities in HLY. The JA: EHLEIS works in collaboration with the USA, Japan and OECD on the development of new SMPHs to be used globally. To strengthen the utility of the HLY for policy-making, annual meetings with policy-makers are planned. Results The information system allows the estimation of a set of health indicators (morbidity and disability prevalence, life and health expectancies) for Europe, Member States and shortly their regional levels. An annual country report on HLY in the national languages is available. The JA: EHLEIS is developing statistical attribution and decomposition tools which will be helpful to determine the impact of specific diseases, life styles or other determinants on differences in HLY. Through a set of international workshops the JA: EHLEIS aims to develop a blueprint for an international harmonized Summary Measure of Population Health. Conclusion The JA: EHLEIS objectives are to monitor progress towards the headline target of the Europe 2020 strategy of increasing HLY by 2 years by 2020 and to support policy development by identifying the main determinants of active and healthy ageing in Europe.
    Full-text · Article · Feb 2013 · Archives of Public Health
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    ABSTRACT: Background: Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging. Methods: We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes). Results: At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis. Interpretation: Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.
    Preview · Article · Oct 2012 · Canadian Medical Association Journal
  • Emmanuelle Cambois · Audrey Blachier · Jean-Marie Robine
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    ABSTRACT: Objectives: The study presents new disability-free life expectancies (DFLE) estimates for France and discusses recent trends in the framework of the three 'health and aging' theories of compression, dynamic equilibrium and expansion of disability. The objectives are to update information for France and to compare two methods to analyse recent trends. Methods: DFLE at ages 50, 65 and in the 50-65 age group are computed for several disability dimensions, using data from five French surveys over the 2000s. Owing to scarce time series, we used two methods to assess trends and consolidate our conclusions: (i) decomposition of the DFLE changes using the available time series; (ii) linear regression using all the available estimates, classified by disability dimensions. Results: Trends in DFLE65 prolonged the dynamic equilibrium of the previous decades: increasing life expectancy with functional limitations but not with activity restrictions. Meanwhile, partial DFLE50-65 has decreased for various disability dimensions, including some activity restrictions, especially for women. Conclusion: France has recently experienced an unexpected expansion of disability in mid-adulthood while it is still on a trend of dynamic equilibrium at older ages. The study highlights the importance of monitoring trends in DFLE for various disability dimensions and broadens the scope of interest to the mid-adulthood.
    No preview · Article · Oct 2012 · The European Journal of Public Health
  • JM Robine · E Cambois · I Romieu

    No preview · Article · Aug 2012
  • E Cambois · JM Robine

    No preview · Article · Aug 2012
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    ABSTRACT: Objectives To evaluated the female–male health–survival paradox by estimating the contribution of women’s mortality advantage versus women’s disability disadvantage. Methods Disability prevalence was measured from the 2006 Survey on Income and Living Conditions in 25 European countries. Disability prevalence was applied to life tables to estimate healthy life years (HLY) at age 15. Gender differences in HLY were split into two parts: that due to gender inequality in mortality and that due to gender inequality in disability. The relationship between women’s mortality advantage or disability disadvantage and the level of population health between countries was analysed using random-effects meta-regression. Results Women’s mortality advantage contributes to more HLY in women; women’s higher prevalence of disability reduces the difference in HLY. In populations with high life expectancy women’s advantage in HLY was small or even a men’s advantage was found. In populations with lower life expectancy, the hardship among men is already evident at young ages. Conclusions The results suggest that the health–survival paradox is a function of the level of population health, dependent on modifiable factors.
    Full-text · Article · May 2012 · International Journal of Public Health
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    Emmanuelle Cambois · Florence Jusot
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    ABSTRACT: Recent research shows that adverse experiences, such as economic hardships or exclusion, contribute to deterioration of health status. However, individuals currently experiencing adverse experiences are excluded from conventional health surveys, which, in addition, often focus on current social situation but rarely address past adverse experiences. This research explores the role of such experiences on health and related social inequalities based on a new set of ad hoc questions included in a regular health survey. In 2004, the National Health, Health Care and Insurance Survey included three questions on lifelong adverse experiences (LAE): financial difficulties, housing difficulties due to financial hardship, isolation. Logistic regressions were used to analyse associations between LAE, current socio-economic status (SES) (education, occupation, income) and health status (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged ≥35 years. LAE were reported by 20% of the sample. They were more frequent in low SES groups but concerned >10% of the highest income group. LAE increased the risk of poor self-perceived health, diseases and activity limitations, even after controlling for current SES [odds ratio (OR) > 2]. LAE experienced only during childhood are also linked to health. LAE account for up to 32% of the OR of activity limitations associated with the lowest quintile among women and 26% among men. LAE contribute to the social health gradient and explain variability within social groups. It is useful to take lifetime social factors into account when monitoring health inequalities.
    Preview · Article · Oct 2011 · The European Journal of Public Health
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    Emmanuelle Cambois · Caroline Laborde · Isabelle Romieu · Jean-Marie Robine
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    ABSTRACT: Increasing life expectancy (LE) raises expectations for social participation at later ages. We computed health expectancies (HE) to assess the (un)equal chances of social/work participation after age 50 in the context of France in 2003. We considered five HEs, covering various health situations which can jeopardize participation, and focused on both older ages and the pre-retirement period. HEs reveal large inequalities for both sexes in the chances of remaining healthy after retirement, and also of reaching retirement age in good health and without disability, especially in low-qualified occupations. These results challenge the policy expectation of an overall increase in social participation at later ages.
    Full-text · Article · Jul 2011 · Demographic Research
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    ABSTRACT: Life expectancy gaps between Eastern and Western Europe are well reported with even larger variations in healthy life years (HLY). To compare European countries with respect to a wide range of health expectancies based on more specific measures that cover the disablement process in order to better understand previous inequalities. Health expectancies at age 50 by gender and country using Sullivan's method were calculated from the Survey of Health and Retirement in Europe Wave 2, conducted in 2006 in 13 countries, including two from Eastern Europe (Poland, the Czech Republic). Health measures included co-morbidity, physical functional limitations (PFL), activity restriction, difficulty with instrumental and basic activities of daily living (ADL), and self-perceived health. Cluster analysis was performed to compare countries with respect to life expectancy at age 50 (LE50) and health expectancies at age 50 for men and women. In 2006 the gaps in LE50 between countries were 6.1 years for men and 4.1 years for women. Poland consistently had the lowest health expectancies, however measured, and Switzerland the greatest. Polish women aged 50 could expect 7.4 years fewer free of PFL, 6.2 years fewer HLY, 5.5 years less without ADL restriction and 9.5 years less in good self-perceived health than the main group of countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden). Substantial inequalities between countries were evident on all health expectancies. However, these differed across the disablement process which could indicate environmental, technological, healthcare or other factors that may delay progression from disease to disability.
    Full-text · Article · Apr 2011 · Journal of epidemiology and community health
  • Emmanuelle Cambois · Caroline Laborde · Jonathan Mandelbaum

    No preview · Article · Jan 2011 · Population (English Edition 2002-)
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    Emmanuelle Cambois · Caroline Laborde

    Preview · Article · Jan 2011 · Population (French Edition)
  • Emmanuelle Cambois · Caroline Laborde
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    ABSTRACT: Mortality differentials between French occupations and occupational classes are large and widening. But considerable inequalities also exist within occu pational classes by career histor y. Change s in the labour market and occupational pathways in recent decades - notably among women - have altered the composition of occupational classes and their average mortality levels. This article analyses the changes in mortality differentials between occupational classes by studying occupational mobility and associated mortality using data from the permanent demographic sample (Échantillon démographique permanent, EDP), a long-term sample representative of the French population at different dates. Analysis of mortality in 1975 (EDP75) and 1999 (EDP99) by occupational class and past occupational moves shows that mortality has declined for all classes but in different ways, causing a slight widening of differentials for both sexes. Within occupational classes, differentials by past moves increased in the EDP99 for men and were now observed in all classes for women. Changes in the composition of occupational classes and in excess mortality associated with certain moves has contributed to this increase in inequalities between occupational classes. This finding highlights the importance of interpreting changes in mortality differentials in the light of sociodemographic developments.
    No preview · Article · Jan 2011 · Population (English Edition 2002-)
  • Emmanuelle Cambois · Caroline Laborde
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    ABSTRACT: Les inégalités de mortalité entre les professions et catégories socioprofessionnelles françaises (PCS) sont importantes et en augmentation. Mais il existe aussi de larges inégalités de mortalité au sein des PCS selon la nature des carrières passées. Les transformations du marché du travail et des parcours professionnels dans les dernières décennies, notamment pour les femmes, modifient la composition des PCS et leur niveau moyen de mortalité. Cet article analyse l'évolution des inégalités de mortalité entre les PCS à travers l'étude des mobilités professionnelles et de la mortalité associée, en utilisant les données de l'Échantillon démographique permanent (EDP), un échantillon suivi et représentatif de la population française à différentes dates. L'étude de la mortalité en 1975 (EDP75) et en 1999 (EDP99), selon les PCS et les mobilités professionnelles passées, montre que la mortalité a baissé pour toutes les PCS mais de façon différente, aboutissant à un léger creusement des écarts pour les deux sexes. Au sein des PCS, les écarts selon les mobilités passées sont renforcés dans TEDP99 pour les hommes et se généralisent pour les femmes. La modification de la composition des PCS et l'évolution de la surmortalité associée à certaines mobilités a contribué à cette augmentation des inégalités entre PCS. Interpréter l'évolution des inégalités de mortalité à la lumière des changements sociodémographiques s'avère donc particulièrement important. Mortality differentials between French occupations and occupational classes are large and widening. But considerable inequalities also exist within occupational classes by career history. Changes in the labour market and occupational pathways in recent decades -notably among women - have altered the composition of occupational classes and their average mortality levels. This article analyses the changes in mortality differentials between occupational classes by studying occupational mobility and associated mortality using data from the Permanent Demographic Sample (Échantillon Démographique Permanent: EDP), a long-term sample representative of the French population at different dates. Analysis of mortality in 1975 (EDP75) and 1999 (EDP99) by occupational class and past occupational moves shows that mortality has declined for all classes but in different ways, causing a slight widening of differentials for both sexes. Within occupational classes, differentials by past moves increased in the EDP99 for men and were now observed in all classes for women. Changes in the composition of occupational classes and in excess mortality associated with certain moves has contributed to this increase in inequalities between occupational classes. This finding highlights the importance of interpreting changes in mortality differentials in the light of sociodemographic developments. Las desigualdades de mortalidad entre las profesiones y categorías socio-profesionales francesas (PCS) son importantes y están todavía aumentando. Pero existen también amplias diferencias de mortalidad dentro de las PCS según la naturaleza de la carrera pasada. Las transformaciones del mercado del trabajo y de los recorridos socio-profesionales en las ultimas décadas, particularmente en las mujeres, han modificado la composición de las PCS y su nivel medio de mortalidad. Este articulo analiza la evolución de las desigualdades de mortalidad entre las PCS a través del estudio de la movilidad profesional y de la mortalidad asociada, utilizando los datos del Echantillon démographique permanent (EDP), es decir un panel observado en continuo y representativo de la población francesa en diferentes fechas. El estudio de la mortalidad en 1975 (EDP1975) y en 1999 (EDP99), según la PCS y la movilidad profesional pasada, muestra que la mortalidad ha disminuido en todas las PCS pero de manera diferente, abocando a un ligero ahondamiento de las diferencias tanto en los hombres como en las mujeres. En el EDP99, dentro de las PCS, las diferencias según la movilidad pasada se refuerzan en los hombres y se generalizan en las mujeres. La modificación de la composición de las PCS y la evolución del exceso de mortalidad asociado a ciertas movilidades han contribuido al aumento de las diferencias entre las PCS. Interpretar la evolución de las desigualdades de mortalidad a la luz de los cambios socio-demográficos se revela pues particularmente importante.
    No preview · Article · Jan 2011 · Population (French Edition)

Publication Stats

1k Citations
117.11 Total Impact Points

Institutions

  • 2005-2015
    • Institut national d'études démographiques
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Max Planck Institute for Demographic Research
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2003
    • Unité Inserm U1077
      Caen, Lower Normandy, France