Article Text

other Versions

Download PDFPDF
Educational inequalities in blood pressure and cholesterol screening in nine European countries
  1. Danielle Rodin1,2,
  2. Irina Stirbu1,3,
  3. Ola Ekholm4,
  4. Dagmar Dzurova5,
  5. Giuseppe Costa6,
  6. Johan P Mackenbach1,
  7. Anton E Kunst1,7
  1. 1Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
  2. 2Faculty of Medicine, University of Toronto, Toronto, Canada
  3. 3NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
  4. 4National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
  5. 5Faculty of Sciences, Charles University Prague, Prague, Czech Republic
  6. 6Department of Public Health and Microbiology, University of Turin, Turin, Italy
  7. 7Department of Public Health, AMC, Amsterdam, the Netherlands
  1. Correspondence to Danielle Rodin, Faculty of Medicine, Medical Sciences Building, 1 Kings College Cir, Toronto, Ontario, M5S 1A8; danielle.rodin{at}


Background To perform the first European overview of educational inequalities in the use of blood pressure and cholesterol screening.

Methods Data were obtained on the use of screening services according to educational level from nationally representative cross-sectional surveys in Belgium, Czech Republic, Denmark, Estonia, Finland, Hungary, Italy, Latvia and Lithuania. Screening rates were examined in the preceding 12 months and 5 years, for respondents 35+ years (45+ for women). ORs comparing low- to high-educated respondents were estimated using logistic regression controlling for age.

Results Inequalities in cholesterol screening favouring higher socioeconomic groups were demonstrated with statistical significance among men in four countries, whereby men with higher education were more likely to receive screening, with 1.22 as the highest OR. Among women, a similar pattern was found. Inequalities in blood pressure screening were even smaller and less often statistically significant. Hungary was the only country with higher rates of both types of screening in the low-educated group. In other countries, pro-high inequalities were slightly increased after controlling for self-rated health.

Conclusions All European countries in this study had small educational inequalities in the utilisation of blood pressure and cholesterol screening. These inequalities are smaller than those previously observed in the USA. Further comparative studies need to distinguish between screening for preventive purposes and screening for treatment and control.

  • Access to health services
  • blood pressure
  • epidemiology
  • preventive medicine
  • social inequalities
  • access to healthcare
  • blood pressure
  • epidemiology
  • inequalities
  • public health
  • statistics
  • study design
  • health behaviour
  • demography
  • Eastern Europe
  • epidemiology
  • geography
  • inequalities
  • public health
  • social epidemiology
  • health expectancy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was carried out as part of the Eurothine project, which is funded by the public health programme of the SANCO Directorate General of the European Commission (grant number 2003125).

  • Competing interests None.

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