International variation in socioeconomic inequalities in self reported health.

A E Kunst, J J Geurts, J van den Berg

Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University, Rotterdam, The Netherlands.

STUDY OBJECTIVE--To assess the extent to which the size of socioeconomic inequalities in self reported health varies among industrialised countries. DESIGN--Cross sectional data on the association between educational level and several health indicators were obtained from national health interview surveys. This association was quantified by means of an inequality index based on logistic regression analysis. SETTING--The national, non-institutionalised populations of the United Kingdom, Sweden, Denmark, Germany, The Netherlands, Italy, the United States, and Canada were studied. The age group was 15-64 years, and the study period was 1983-90. PARTICIPANTS--Representative population samples with the number of respondents ranging from approximately 6000 (Denmark) to 90,000 (the United States) were studied. MAIN RESULTS--For men, the smallest health inequalities were observed for the United Kingdom and Sweden, and the largest inequalities for Italy and the United States. Other countries held an intermediate position. The same international pattern was observed for women, except that relatively small inequalities were also observed for Dutch women. CONCLUSIONS--The results agree to a large extent with those of previous comparative studies. The international pattern observed here may be partly related to "subjective" aspects of self reported health, such as the propensity to complain and illness behaviour. The results challenge the view that disease and disability are distributed less equally in the UK than in countries like Sweden.

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