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Rasmus Hoffmann

EURO-GBD-SE The potential for reduction of health inequalities in Europe www.euro-gbd-se.eu Short introduction into our project. Rasmus Hoffmann. Main objectives.

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Rasmus Hoffmann

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  1. EURO-GBD-SE The potential for reduction of health inequalities in Europewww.euro-gbd-se.euShort introduction into our project Rasmus Hoffmann

  2. Main objectives • The EURO-GBD-SE project aims at assessing the potential for reduction of health inequalities in Europe, by first identifying the determinants and risk factors associated with variations in the magnitude of health inequalities between European countries. • The second step is to use these measures to develop counterfactual scenarios by using epidemiological calculation methods (Population Attributable Fraction). • The project estimates the extent to which health inequalities in Europe can (theoretically and realistically) be reduced by policies and interventions on socioeconomic determinants as well as on specific risk factors. • Updated estimates of the magnitude of socioeconomic inequalities in health in Europe.

  3. Scenarios • 2 main scenarios • Changing the distribution of education • Changing the exposure to a risk factor (by socioeconomic group) • Together, the risk factor scenarios and the more radical educational redistribution scenarios provide a good first picture of the theoretical potential for reduction of educational health inequalities. • Europe offers excellent opportunities for such analyses • Data on inequalities in mortality, morbidity and risk factors are available in many countries. • European welfare systems differ substantially • Variations of health inequalities are already found.

  4. Data preparation The project has collected four kinds of data: • Educational distributions • Prevalences of risk factors (RF) • by country, sex, age and education. The primary source is Health Survey data. • Rate Ratios (RRs) • for the impact of RFs on health outcomes. • assumingly reflecting the causal relationship between the RFs and health. • Mortality rates • by country, sex, age, education, for all-cause mortality and by causes of death • From the mortality rates we calculated RRs between educational groups by country, sex, age, for all-cause and cause-specific mortality.

  5. Risk factors - Smoking - BMI - Physical activity - Diabetes - Fruit/vegetables - Social participation - Occupational status - Activity status - Income (alcohol has been skipped). Details about the methods can be found in Hoffmann et al. 2012 (JECH) We calculate PAF’s for - 21 European populations - men and women - 4 age groups (30-79) - 3 educational groups - for all-cause mortality and 22 causes of death.

  6. Percentage reduction of mortality in maximum educational scenarioKulhanova I, Hoffmann R et al (in preparation)

  7. Number and percentage of saved deaths from all cause mortality among menper 100.000 among low and mid educatedUpward leveling scenario where the exposure to each risk factor is as among the high educated

  8. Mortality RRs, scenario RRs and potential reduction of inequality in mortality (in%) between high and low educated persons in different smoking scenarios (Kulik M, Hoffmann R et al, in preparation)

  9. General results and conclusions First, the EURO-GBD-SE project has shown that inequalities in mortality and morbidity in Europe have persisted into the 21st century, and manifest themselves in patterns that are broadly similar to those seen in the 1990s. This implies that they continue to be one of the main challenges for public health policy. Second, EURO-GBD-SE has shown that the explanation of inequalities in mortality, in terms of the quantitative contribution of specific risk factors, differs between European countries. This implies that different countries have different entry-points for policies against health inequalities. Third, EURO-GBD-SE has shown that many countries can reduce relative inequalities in mortality by up to 10, 20 or even 30% if they would succeed in reducing inequalities in one or more risk factors to the level currently seen in the European country with the smallest inequalities in exposure.

  10. Thank you!

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