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The article by Mackenbach et al1 addresses educational inequalities in mortality at the turn of the 21st century by examining trends between the 1990s and the 2000s. Using harmonised data from official mortality registers, this study consists of a comprehensive mapping exercise: it includes 13 European countries, a breakdown of mortality into causes and it uses absolute as well as relative measures of inequality.
Both absolute and relative measures are meaningful for monitoring health inequalities. While absolute measures may be more useful for public-health policy, relative measures are particularly apt for analytical purposes, especially when the overall mortality level is taken into account.2 By doing so, Mackenbach et al1 draw a finely tuned picture of mortality inequalities in Europe that transcends ‘half-full/half-empty discussions’. Their encompassing account of mortality inequalities in Europe furthermore allows moving beyond mere description into the realm of explanations. Cross-country comparisons of mortality inequalities enable us to identify more distal determinants of inequalities, whereas the assessment of cause-specific mortality enables the identification of more proximal determinants.
The study by Mackenbach et al1 reveals that relative mortality inequalities remain stable at best and are actually widening in many European countries between the 1990s and the 2000s. Zooming in on absolute mortality inequalities, the picture looks …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
↵i Henceforth, we will use the term socioeconomic status (SES) to indicate someone's standing in the stratification system. Although SES is much broader a concept than education, we think it is appropriate to couch the following in terms of SES. Since inequalities in health behaviours and mortality have been shown according to a number of SES measures, suggesting that the particular SES measure used is not of key importance here.
↵ii The results of Mackenbach et al1 are in agreement with these previous studies, since, conversely to the trend of deepening absolute inequalities in mortality from external causes, liver cirrhosis and lung cancer, the trend in all-cause mortality is one of narrowing absolute inequalities.