Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study
- Hadewijch Vandenheede1,2,
- Olga Vikhireva1,
- Hynek Pikhart1,
- Ruzena Kubinova3,
- Sofia Malyutina4,5,
- Andrzej Pajak6,
- Abdonas Tamosiunas7,
- Anne Peasey1,
- Galina Simonova4,
- Roman Topor-Madry6,
- Michael Marmot1,
- Martin Bobak1
- 1Research Department of Epidemiology and Public Health, University College London, London, UK
- 2Department of Sociology, Faculty of Economic, Social and Political Sciences and Solvay Business School, Vrije Universiteit Brussel, Brussels, Belgium
- 3National Institute of Public Health, Prague, Czech Republic
- 4Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia
- 5Novosibirsk State Medical University, Novosibirsk, Russia
- 6Department of Epidemiology and Population Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
- 7Laboratory of Population Research, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Correspondence to Professor Hadewijch Vandenheede, Department of Sociology, Faculty of Economic, Social and Political Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 5, Brussels 1050, Belgium;
- Received 3 July 2013
- Revised 20 September 2013
- Accepted 25 September 2013
- Published Online First 13 November 2013
Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP.
Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16 812 men and 19 180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences.
Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators.
Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU.
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