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Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries

2014; BMJ; Volume: 69; Issue: 3 Linguagem: Inglês

10.1136/jech-2014-204450

1470-2738

Hadewijch Vandenheede,

Employment and Welfare Studies

The article by Mackenbach et al 1 addresses educational inequalities in mortality at the turn of the 21st century by examining trends between the 1990s and the 2000s. Using harmonised data from official mortality registers, this study consists of a comprehensive mapping exercise: it includes 13 European countries, a breakdown of mortality into causes and it uses absolute as well as relative measures of inequality. Both absolute and relative measures are meaningful for monitoring health inequalities. While absolute measures may be more useful for public-health policy, relative measures are particularly apt for analytical purposes, especially when the overall mortality level is taken into account.2 By doing so, Mackenbach et al 1 draw a finely tuned picture of mortality inequalities in Europe that transcends ‘half-full/half-empty discussions’. Their encompassing account of mortality inequalities in Europe furthermore allows moving beyond mere description into the realm of explanations. Cross-country comparisons of mortality inequalities enable us to identify more distal determinants of inequalities, whereas the assessment of cause-specific mortality enables the identification of more proximal determinants. The study by Mackenbach et al 1 reveals that relative mortality inequalities remain stable at best and are actually widening in many European countries between the 1990s and the 2000s. Zooming in on absolute mortality inequalities, the picture looks …