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Educational inequalities in avoidable mortality in Europe
  1. Irina Stirbu1,
  2. Anton E Kunst1,
  3. Matthias Bopp2,
  4. Mall Leinsalu3,4,
  5. Enrique Regidor5,
  6. Santiago Esnaola6,
  7. Giuseppe Costa7,8,
  8. Pekka Martikainen9,
  9. Carme Borrell10,
  10. Patrik Deboosere11,
  11. Ramune Kalediene12,
  12. Jitka Rychtarikova13,
  13. Barbara Artnik14,
  14. Johan P Mackenbach1
  1. 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  3. 3Stockholm Centre on Health of Societies in Transition, Södertorn University College, Södertorn, Sweden
  4. 4Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  5. 5Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
  6. 6Research Unit, Department of Health, Basque Government, Vitoria-Gasteiz, Spain
  7. 7Regional Epidemiology Unit, ASL T03 Piedmont Region, Grugliasco, Italy
  8. 8Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
  9. 9Department of Sociology, University of Helsinki, Helsinki, Finland
  10. 10Agència de Salut Pública de Barcelona, Barcelona, Spain
  11. 11Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium
  12. 12Kaunas University of Medicine, Kaunas, Lithuania
  13. 13Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, the Czech Republic
  14. 14Department of Public Health, Faculty of Medicine, Ljubljana University, Ljubljana, Slovenia
  1. Correspondence to Johan Mackenbach, Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; j.mackenbach{at}


Background The magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations was compared, and the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe was determined.

Methods Mortality data were obtained for people aged 30–64 years. For each country, the association between level of education and avoidable mortality was measured with the use of regression-based inequality indexes. Life table analysis was used to calculate the contribution of avoidable causes of death to inequalities in life expectancy between lower and higher educated groups.

Results Educational inequalities in avoidable mortality were present in all countries of Europe and in all types of avoidable causes of death. Especially large educational inequalities were found for infectious diseases and conditions that require acute care in all countries of Europe. Inequalities were larger in Central Eastern European (CEE) and Baltic countries, followed by Northern and Western European countries, and smallest in the Southern European regions. This geographic pattern was present in almost all types of avoidable causes of death. Avoidable mortality contributed between 11 and 24% to the inequalities in Partial Life Expectancy between higher and lower educated groups. Infectious diseases and cardiorespiratory conditions were the main contributors to this difference.

Conclusions Inequalities in avoidable mortality were present in all European countries, but were especially pronounced in CEE and Baltic countries. These educational inequalities point to an important role for healthcare services in reducing inequalities in health.

  • Avoidable mortality
  • education
  • inequalities
  • Europe
  • health services research
  • public health Europe
  • avoidable
  • education
  • mortality

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  • Funding This investigation has been funded by the Health & Consumer Protection Directorate-General of the European Union and was carried out as a part of the Eurothine project (Grant number 2003125). The study sponsors have not influenced in any form study design, collection, analysis and interpretation of data, writing of the paper and decision to submit it for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.