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

Chen-Xu, J. et al. (2024) Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009–19: an ecological study. Lancet Public Health, 9(3), e166-e177. (doi: 10.1016/S2468-2667(24)00004-5)

Abstract

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. 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.

• Item Type: Articles
• Additional Information: The authors would like to acknowledge the networking support from the European Burden of Disease Network (Action CA18218), supported by the European Cooperation in Science and Technology. The authors alone are responsible for the views expressed in this Article. Contributions of CMB, MB, and TAE were supported by a grant awarded by the Research Council of Norway (project number 288638) to the Centre for Global Health Inequalities Research at the Norwegian University for Science and Technology and Centre for Disease Burden at the Norwegian Institute of Public Health. The contribution of NM and OV was supported by a grant funded by the National Research, Development, and Innovation Fund of Hungary (research project FI17198). JCX was supported by CA18218 with a Virtual Mobility Grant (E-COST-GRANT-CA18218-b4552282).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wyper, Dr Grant
• Authors: Chen-Xu, J., Varga, O., Mahrouseh, N., Eikemo, T. A., Grad, D. A., Wyper, G. M.A., Badache, A., Balaj, M., Charalampous, P., Economou, M., Haagsma, J. A., Haneef, R., Mechili, E. A., Unim, B., von der Lippe, E., and Baravelli, C. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Lancet Public Health
• Publisher: Elsevier
• ISSN: 2468-2667
• ISSN (Online): 2468-2667
• Published Online: 28 February 2024
• Copyright Holders: Copyright © 2024 The Author(s).
• First Published: First published in Lancet Public Health 9(3):e166-e177
• Publisher Policy: Reproduced under a Creative Commons license