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Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010
  1. Yannan Hu1,
  2. Frank J van Lenthe1,
  3. Gerard J Borsboom1,
  4. Caspar W N Looman1,
  5. Matthias Bopp2,
  6. Bo Burström3,
  7. Dagmar Dzúrová4,
  8. Ola Ekholm5,
  9. Jurate Klumbiene6,
  10. Eero Lahelma7,
  11. Mall Leinsalu8,9,
  12. Enrique Regidor10,
  13. Paula Santana11,
  14. Rianne de Gelder1,
  15. Johan P Mackenbach1
  1. 1Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  3. 3Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic
  5. 5National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  6. 6Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
  7. 7Department of Public Health, University of Helsinki, Helsinki, Finland
  8. 8Stockholm Centre on Health of Societies in Transition, Södertörn University, Huddinge, Sweden
  9. 9Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  10. 10Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
  11. 11Departamento de Geografia, Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
  1. Correspondence to Professor Johan P Mackenbach, Department of Public Health, Erasmus MC, P.O. Box 2040 Rotterdam, 3000 CA, The Netherlands; j.mackenbach{at}


Background Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.

Methods Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30–79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities.

Results We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities.

Conclusions Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.

  • Health inequalities

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