Zusammenfassung
Hintergrund
Im Jahr 1989 erschienen die ersten Ländervergleiche zu Mortalitätsunterschieden nach Bildung und Berufsstatus. Wenige Jahre später begannen die systematischen Ländervergleiche an der Erasmus-Universität in Rotterdam, die mehrere europäische Kollaborationsprogramme zur Erforschung sozialer Unterschiede in der Gesundheit auslösten. Dabei zeigten sich markante Sterblichkeitsunterschiede in und zwischen europäischen Populationen.
Zielsetzung
Diese Arbeit soll eine Synthese der wichtigsten Forschungsresultate aus den letzten 30 Jahren liefern und auf noch bestehende Lücken und Potenziale hinweisen.
Material und Methoden
Deskriptive Synthese der Forschungsresultate aus europäischen Ländervergleichen der Gesamt- und ursachenspezifischen Sterblichkeit nach Geschlecht, Bildungsstand und Berufsstatus.
Ergebnisse
Überall in Europa zeigt sich ein konsistentes Gefälle mit erheblichen und teilweise zunehmenden Vorteilen für statushöhere Gruppen – allerdings mit beträchtlichen Unterschieden zwischen den einzelnen Ländern. Dies gilt auch für Trends und todesursachenspezifische Auswertungen. Die relativen Unterschiede haben praktisch durchwegs zugenommen, die absoluten dagegen bei etlichen Populationen abgenommen. Bei Frauen und mit zunehmendem Alter sind die relativen Unterschiede kleiner. Innerhalb Europas sind die Unterschiede im Süden am geringsten und im Osten am größten. Eine besondere Rolle für die Trends und Gradienten spielen die tabak- und alkoholassoziierten Krankheiten.
Schlussfolgerung
Die Evidenz für soziale Unterschiede im Gesundheitszustand und ihre Determinanten hat sich in den letzten 30 Jahren signifikant verbessert. In Zukunft sind wichtige weitere Fragestellungen denkbar, z. B. welche Lebensphasen wie viel beitragen für ein gesundes Altern.
Abstract
Background
In 1989 the first international comparisons of mortality differences according to educational level and occupational status were published. A few years later systematic comparisons between European countries were initiated at the Erasmus University in Rotterdam. This became a trigger for several European Union (EU)-funded collaboration programs scrutinizing social inequalities in health. The collaboration revealed substantial differences in mortality within and between European populations.
Objective
This article provides a synthesis of the most important research results over the past 30 years and also identifies existing research gaps and potentials.
Material and methods
Descriptive summary of research results comparing European countries regarding male and female all-cause and cause-specific mortality according to educational level and occupational status.
Results
In all European populations analyzed there was a consistent gradient with substantial and in part increasing advantages for higher socioeconomic status groups. There is, however, substantial variation between individual countries. This also applies to trends and cause of death-specific analyses. While relative differences have increased in virtually all populations, absolute differences have often decreased in many populations. Among women and in higher ages the relative differences were smaller. Within Europe, the southern countries had the smallest and the eastern countries the largest gradients. Tobacco and alcohol-related diseases had an especially noteworthy impact on trends and gradients.
Conclusion
The evidence for social health inequalities and their determinants has substantially improved during the past 30 years; however, there remains substantial potential for future research questions, for example concerning the contribution of the different phases of life to healthy aging.
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M. Bopp und J.P. Mackenbach geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Bopp, M., Mackenbach, J.P. Vor dem Tod sind alle ungleich. Z Gerontol Geriat 52, 122–129 (2019). https://doi.org/10.1007/s00391-019-01530-6
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DOI: https://doi.org/10.1007/s00391-019-01530-6