Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19: an ecological study.

Journal

The Lancet. Public health
ISSN: 2468-2667
Titre abrégé: Lancet Public Health
Pays: England
ID NLM: 101699003

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 13 07 2023
revised: 08 01 2024
accepted: 09 01 2024
medline: 2 3 2024
pubmed: 2 3 2024
entrez: 1 3 2024
Statut: ppublish

Résumé

Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic. In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models. Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]). Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA. Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.

Sections du résumé

BACKGROUND BACKGROUND
Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic.
METHODS METHODS
In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models.
FINDINGS RESULTS
Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]).
INTERPRETATION CONCLUSIONS
Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA.
FUNDING BACKGROUND
Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.

Identifiants

DOI: 10.1016/S2468-2667(24)00004-5 PMID: 38429016
pubmed: 38429016
pii: S2468-2667(24)00004-5
doi: 10.1016/S2468-2667(24)00004-5
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e166-e177

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests We declare no competing interests.

Auteurs

José Chen-Xu (J)

Comprehensive Health Research Centre, Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal; Public Health Unit, Local Health Unit Baixo Mondego, Figueira da Foz, Portugal.

Orsolya Varga (O)

Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Syreon Research Institute, Budapest, Hungary.

Nour Mahrouseh (N)

Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Terje Andreas Eikemo (TA)

Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway.

Diana A Grad (DA)

Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania.

Grant M A Wyper (GMA)

School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Population Health and Wellbeing, Public Health Scotland, Glasgow, Scotland.

Andreea Badache (A)

Swedish Institute of Disability Research, School of Health Sciences, Örebro University, Örebro, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.

Mirza Balaj (M)

Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway.

Periklis Charalampous (P)

Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Mary Economou (M)

Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.

Juanita A Haagsma (JA)

Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Romana Haneef (R)

Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France.

Enkeleint A Mechili (EA)

Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania; School of Medicine, University of Crete, Crete, Greece.

Brigid Unim (B)

Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy.

Elena von der Lippe (E)

Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.

Carl Michael Baravelli (CM)

Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway. Electronic address: carlmichael.baravelli@fhi.com.

Classifications MeSH