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Educational inequalities in avoidable mortality in Europe
  1. Irina Stirbu1,*,
  2. A E Kunst2,
  3. Matthias Bopp3,
  4. Mall Leinsalu4,
  5. Enrique Regidor5,
  6. Santiago Esnaola6,
  7. Giuseppe Costa7,
  8. Pekka Martikainen8,
  9. Carme Borrell9,
  10. Ramune Kalediene10,
  11. Jitka Rychtarikova11,
  12. Barbara Artnik12,
  13. Patrick Deboosere13,
  14. Johan P Mackenbach14
  1. 1 Erasmus Medical Center, Netherlands;
  2. 2 Erasmus MC, Netherlands;
  3. 3 Institute of Social and Preventive Medicine, University of Zurich, Switzerland;
  4. 4 Stockholm Centre on Health of Societies in Transition, Södertörns University College, Sweden;
  5. 5 Universidad Complutense de Madrid, Spain;
  6. 6 Research Unit, Department of Health, Basque Government, Spain;
  7. 7 Department of Hygiene and Public Health, University of Turin, Italy;
  8. 8 Department of Sociology, University of Helsinki, Helsinki, Finland;
  9. 9 Agència de Salut Pública de Barcelona, Barcelona, Spain;
  10. 10 Kaunas University of Medicine, Kaunas, Lithuania;
  11. 11 Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czech Republic;
  12. 12 Department of Public Health, Faculty of Medicine, Ljubljana University, Slovenia;
  13. 13 Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium;
  14. 14 Erasmus MC, University Medicall Center Rotterdam, Netherlands
  1. Correspondence to: Irina Stirbu, Erasmus Medical Center, Dr Molewaterplein 50, Rotterdam, 3000, Netherlands; i.stirbu{at}


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

Methods: We obtained mortality data 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 cardio-respiratory conditions were main contributors to this difference.

Conclusion: 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 of healthcare services in reducing inequalities in health.

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