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Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19: an ecological study
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.
Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Syreon Research Institute, Budapest, Hungary.
Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway.
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2024 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 9, no 3, p. e166-e177Article in journal (Refereed) Published
Abstract [en]

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: 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: 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: 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.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 9, no 3, p. e166-e177
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-112082DOI: 10.1016/S2468-2667(24)00004-5ISI: 001225718400001PubMedID: 38429016Scopus ID: 2-s2.0-85186449459OAI: oai:DiVA.org:oru-112082DiVA, id: diva2:1842181
Funder
The Research Council of Norway, 288638
Note

Funding:

Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.

Available from: 2024-03-04 Created: 2024-03-04 Last updated: 2024-06-11Bibliographically approved

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