To Örebro University

Background and Objectives: Inequalities in life expectancy and years of life lost (YLL) are key measures of disease burden within a population. Although European countries aim for convergence in health status, few comparative studies have addressed health inequalities at the sub-national level. This study aimed to examine all-cause YLL by sub-national NUTS2 regions in the European Economic Area (EEA) and assess level of regional inequality in YLL rates through the Gini Coefficient (GC), between males and females in 2019.

Methods: To quantify existing inequalities, we extracted from Eurostat (2019) socio-economic data, age-standardised population, and deaths by all causes for 296 NUTS2 regions across the EEA. Residual life expectancy was retrieved from the Global Burden of Disease study (2019). Age-standardised YLL (expressed as rate/100,000 inhabitants) and GC of sub-national inequalities in YLL rates were calculated with 95% Confidence Intervals (CI) using STATA.

Results: The highest YLL in 2019 for females were observed in Bulgaria (Severozapaden), with 24,102 (CI 20,769–27,434), followed by Hungary (Észak-Magyarország) with 22,532 (CI 20,100–24,963). For males, the highest YLL values were again in Bulgaria (Severozapaden) with 43,523 (CI 38,854–48,192), followed by Romania (Southeast region), with 42,390 (CI 39,717–45,062). Overall, there were higher GC for sub-national YLL rates across countries in males (0,15; CI 0,14–0,16) compared to females (0,12; CI 0,11–0,13). France (0,08; CI 0,02–0,14) and Portugal (0,08; CI 0,04–0,11) had the highest GC for females, whereas the highest GC for males were estimated for Belgium (0,08; CI 0,06–0,11) and Portugal (0,08 CI 0,05–0,11).

Conclusion: Our comparative analyses showed that regions located in Eastern and Central European countries had the highest YLL, while Western European countries had the highest GC values, indicating larger inequalities in premature mortality within these countries. Public health strategies need to take into account these regional health inequalities for future policies and interventions.