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Lundberg, Olle
Publications (10 of 15) Show all publications
Mackenbach, J. P., Kulhanova, I., Artnik, B., Bopp, M., Borrell, C., Clemens, T., . . . de Gelder, R. (2016). Changes in mortality inequalities over two decades: register based study of European countries. BMJ. British Medical Journal, 353, Article ID i1732.
Open this publication in new window or tab >>Changes in mortality inequalities over two decades: register based study of European countries
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2016 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 353, article id i1732Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. DESIGN Register based study. DATA SOURCE Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). SETTING All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. RESULTS Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. CONCLUSIONS Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-27811 (URN)10.1136/bmj.i1732 (DOI)000374375100001 ()27067249 (PubMedID)2-s2.0-84964318422 (Scopus ID)
Available from: 2016-06-08 Created: 2016-06-07 Last updated: 2017-11-30Bibliographically approved
Mackenbach, J. P., Kulhanova, I., Menvielle, G., Bopp, M., Borrell, C., Costa, G., . . . Lundberg, O. (2015). Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. Journal of Epidemiology and Community Health, 69(3), 207-217
Open this publication in new window or tab >>Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries
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2015 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 3, p. 207-217Article in journal (Refereed) Published
Abstract [en]

Background Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century. Methods We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia. Results Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries. Conclusions Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-24589 (URN)000349542100004 ()24964740 (PubMedID)2-s2.0-84924034981 (Scopus ID)
Available from: 2015-03-17 Created: 2015-03-17 Last updated: 2017-09-14Bibliographically approved
Mackenbach, J. P., Kulhánová, I., Bopp, M., Deboosere, P., Eikemo, T. A., Hoffmann, R., . . . White, C. (2015). Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the "fundamental causes" theory of social inequalities in health. Social Science and Medicine, 127, 51-62
Open this publication in new window or tab >>Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the "fundamental causes" theory of social inequalities in health
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2015 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, p. 51-62Article in journal (Refereed) Published
Abstract [en]

Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities.We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30-79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable.Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education-mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large.In conclusion, our results provide some further support for the theory of "fundamental causes". However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.

Keywords
Causes of death, Education, Europe, Fundamental causes, Inequality, Mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-24603 (URN)10.1016/j.socscimed.2014.05.021 (DOI)000350074800006 ()2-s2.0-84922333690 (Scopus ID)
Note

CODEN: SSMDE

Available from: 2015-03-26 Created: 2015-03-17 Last updated: 2017-12-04Bibliographically approved
Mäki, N. E., Martikainen, P. T., Eikemo, T., Menvielle, G., Lundberg, O., Östergren, O. & Mackenbach, J. P. (2014). The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking. Journal of Epidemiology and Community Health, 68(7), 635-640
Open this publication in new window or tab >>The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking
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2014 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 7, p. 635-640Article in journal (Refereed) Published
Abstract [en]

Introduction This study assesses the effects of obesity, physical inactivity and smoking on life expectancy (LE) differences between educational groups in five European countries in the early 2000s. Methods We estimate the contribution of risk factors on LE differences between educational groups using the observed risk factor distributions and under a hypothetically more optimal risk factor distribution. Data on risk factor prevalence were obtained from the Survey of Health, Ageing and Retirement in Europe study, and data on mortality from census-linked data sets for the age between 50 and 79 according to sex and education. Results Substantial differences in LE of up to 2.8 years emerged between men with a low and a high level of education in Denmark, Austria and France, and smaller differences among men in Italy and Spain. The educational differences in LE were not as large among women. The largest potential for reducing educational differences was in Denmark (25% among men and 41% among women) and Italy (14% among men). Conclusions The magnitude of the effect of unhealthy behaviours on educational differences in LE varied between countries. LE among those with a low or medium level of education could increase in some European countries if the behavioural risk factor distributions were similar to those observed among the highly educated.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-22599 (URN)10.1136/jech-2013-203501 (DOI)000337894200009 ()2-s2.0-84901950092 (Scopus ID)
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2017-12-05Bibliographically approved
Mäki, N., Martikainen, P., Eikemo, T., Menvielle, G., Lundberg, O., Östergren, O., . . . Mackenbach, J. P. (2013). Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries. Social Science and Medicine, 94, 1-8
Open this publication in new window or tab >>Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries
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2013 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 94, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Healthy life expectancy is a composite measure of length and quality of life and an important indicator of health in aging populations. There are few cross-country comparisons of socioeconomic differences in healthy life expectancy. Most of the existing comparisons focus on Western Europe and the United States, often relying on older data. To address these deficiencies, we estimated educational differences in disability-free life expectancy for eight countries from all parts of Europe in the early 2000s. Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a recent project comparing health inequalities between European countries (the EURO-GBD-SE project). We calculated sex-specific educational differences in disability-free life expectancy between the ages of 30 and 79 years using the Sullivan method. The lowest disability-free life expectancy was found among Lithuanian men and women (33.1 and 39.1 years, respectively) and the highest among Italian men and women (42.8 and 44.4 years, respectively). Life expectancy and disability-free life expectancy were directly related to the level of education, but the educational differences were much greater in the latter in all countries. The difference in the disability-free life expectancy between those with a primary or lower secondary education and those with a tertiary education was over 10 years for males in Lithuania and approximately 7 years for males in Austria, Finland and France, as well as for females in Lithuania. The difference was smallest in Italy (4 and 2 years among men and women, respectively). Highly educated Europeans can expect to live longer and spend more years in better health than those with lower education. The size of the educational difference in disability-free life expectancy varies significantly between countries. The smallest and largest differences appear to be in Southern Europe and in Eastern and Northern Europe, respectively. (C) 2013 Elsevier Ltd. All rights reserved.

Keywords
Census-linked mortality data, Disability-free life expectancy, Educational differences, EU-SILC survey data, Europe, Long-standing activity limitation, Sullivan's method
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-19951 (URN)10.1016/j.socscimed.2013.06.009 (DOI)000323809300001 ()2-s2.0-84881363968 (Scopus ID)
Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-12-06Bibliographically approved
Pega, F., Kawachi, I., Rasanathan, K. & Lundberg, O. (2013). Politics, policies and population health: A commentary on Mackenbach, Hu and Looman (2013). Social Science and Medicine, 93(S1), 176-179
Open this publication in new window or tab >>Politics, policies and population health: A commentary on Mackenbach, Hu and Looman (2013)
2013 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 93, no S1, p. 176-179Article in journal, Editorial material (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-20656 (URN)10.1016/j.socscimed.2013.06.007 (DOI)000324608500022 ()2-s2.0-84881027136 (Scopus ID)
Available from: 2013-12-12 Created: 2013-12-11 Last updated: 2017-12-06Bibliographically approved
Pega, F., Carter, K., Kawachi, I., Davis, P., Gunasekara, F. I., Lundberg, O. & Blakely, T. (2013). The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders. Journal of Epidemiology and Community Health, 67(8), 682-688
Open this publication in new window or tab >>The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders
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2013 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 8, p. 682-688Article in journal (Refereed) Published
Abstract [en]

Background In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. Methods We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. Results Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (=0.001, 95% CI -0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI -0.005 to 0.011). Conclusions This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-20657 (URN)10.1136/jech-2012-202300 (DOI)000321337200010 ()2-s2.0-84885361134 (Scopus ID)
Available from: 2013-12-12 Created: 2013-12-11 Last updated: 2017-12-06Bibliographically approved
Bergqvist, K., Åberg Yngwe, M. & Lundberg, O. (2013). Understanding the role of welfare state characteristics for health and inequalities - an analytical review. BMC Public Health, 13, Art. no. 1234
Open this publication in new window or tab >>Understanding the role of welfare state characteristics for health and inequalities - an analytical review
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. Art. no. 1234-Article, review/survey (Refereed) Published
Abstract [en]

Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

Keywords
Health inequalities, Health, Welfare regime, Social expenditure, Welfare institutions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-21989 (URN)10.1186/1471-2458-13-1234 (DOI)000331284400001 ()2-s2.0-84890991197 (Scopus ID)
Available from: 2014-06-04 Created: 2014-05-28 Last updated: 2017-12-05Bibliographically approved
Stickley, A., Leinsalu, M., Kunst, A. E., Bopp, M., Strand, B. H., Martikainen, P., . . . Mackenbach, J. P. (2012). Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries. European Journal of Epidemiology, 27(11), 877-884
Open this publication in new window or tab >>Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries
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2012 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 11, p. 877-884Article in journal (Refereed) Published
Abstract [en]

Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35-64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5 % at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.

Keywords
Education; Europe; Homicide; Inequality
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology
Identifiers
urn:nbn:se:miun:diva-18293 (URN)10.1007/s10654-012-9717-3 (DOI)000311311500006 ()2-s2.0-84871312712 (Scopus ID)
Available from: 2013-01-16 Created: 2013-01-16 Last updated: 2017-12-06Bibliographically approved
Van Raalte, A., Kunst, A., Lundberg, O., Leinsalu, M., Martikainen, P., Artnik, B., . . . Mackenbach, J. (2012). The contribution of educational inequalities to lifespan variation. Population Health Metrics, 10, Art. no. 3
Open this publication in new window or tab >>The contribution of educational inequalities to lifespan variation
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2012 (English)In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 10, p. Art. no. 3-Article in journal (Refereed) Published
Abstract [en]

Background: Studies of socioeconomic inequalities in mortality consistently point to higher death rates in lower socioeconomic groups. Yet how these between-group differences relate to the total variation in mortality risk between individuals is unknown.Methods: We used data assembled and harmonized as part of the Eurothine project, which includes census-based mortality data from 11 European countries. We matched this to national data from the Human Mortality Database and constructed life tables by gender and educational level. We measured variation in age at death using Theil’s entropy index, and decomposed this measure into its between- and within-group components.Results: The least-educated groups lived between three and 15 years fewer than the highest-educated groups, the latter having a more similar age at death in all countries. Differences between educational groups contributed between 0.6% and 2.7% to total variation in age at death between individuals in Western European countries and between 1.2% and 10.9% in Central and Eastern European countries. Variation in age at death is larger and differs more between countries among the least-educated groups.Conclusions: At the individual level, many known and unknown factors are causing enormous variation in age at death, socioeconomic position being only one of them. Reducing variations in age at death among less-educated people by providing protection to the vulnerable may help to reduce inequalities in mortality between socioeconomic groups. 

Keywords
Education; International variation; Life expectancy; Lifespan variation; Mortality; Socioeconomic inequality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-16742 (URN)10.1186/1478-7954-10-3 (DOI)000302234400001 ()2-s2.0-84856935277 (Scopus ID)
Available from: 2012-08-20 Created: 2012-08-17 Last updated: 2017-12-07Bibliographically approved
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