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Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009
  1. Emmanuelle Cambois1,
  2. Aïda Solé-Auró2,
  3. Henrik Brønnum-Hansen3,
  4. Viviana Egidi4,
  5. Carol Jagger5,
  6. Bernard Jeune6,
  7. Wilma J Nusselder7,
  8. Herman Van Oyen8,
  9. Chris White9,
  10. Jean-Marie Robine10
  1. 1Department of Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France
  2. 2Department of Political and Social Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain
  3. 3Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
  4. 4Department of Statistical Science, Sapienza University of Rome, Roma, Italy
  5. 5Newcastle University Institute for Ageing and Institute of Health & Society, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
  6. 6Department of Epidemiology, Institute of Public Health, and Danish Ageing Research Center, University of Southern Denmark, Odense, Denmark
  7. 7Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  8. 8Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
  9. 9Government Statistical Service, Office for National Statistics, Government Buildings, Newport, UK
  10. 10Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), Montpellier, France
  1. Correspondence to Dr Emmanuelle Cambois, Department of Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), 133 Bd Davout, Paris 75980, Cedex 20, France; cambois{at}


Background Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes.

Methods Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30–79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups.

Results The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0–1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7–2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8–1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4–0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups.

Conclusions The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.

  • Functioning and disability

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