Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Archives of Public Health
Published in: Archives of Public Health 1/2017

Open Access 01-12-2017 | Research

Educational inequalities in premature mortality by region in the Belgian population in the 2000s

Authors: Françoise Renard, Brecht Devleesschauwer, Sylvie Gadeyne, Jean Tafforeau, Patrick Deboosere

Published in: Archives of Public Health | Issue 1/2017

Login to get access

Abstract

Background

In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population.

Methods

Residents with Belgian nationality at birth registered in the census 2001 aged 25–64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death.

Results

Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences.

Conclusions

For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes.
Appendix
Available only for authorised users
Literature
1.
WHO Regional Office for Europe. Health 21: the health for all policy framework for the WHO European region. Copenhagen: World Health Organization; 1999.
2.
Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.CrossRefPubMed
3.
Executive Agency for Health and Consumer. Second Programme of Community Action in the Field of Health 2008–2013. European Commission; 2007.
4.
Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. J Health Popul Nutr. 2003;21(3):181–92.PubMed
5.
Deboosere P, Gadeyne S, Van Oyen H. The 1991–2004 evolution in life expectancy by educational level in Belgium based on linked census and population register data. Eur J Popul. 2008;25(2):175–96.CrossRef
6.
Gadeyne S. The ultimate inequality : socio-economic differences in all-cause and cause-specific mortality in Belgium on the first part of the 1990s. Centrum voor Bevolking en Gezinsstudie: Brussels; 2006.
7.
Bossuyt N, Gadeyne S, Deboosere P, Van Oyen H. Socio-economic inequalities in health expectancy in Belgium. Public Health. 2004;118(1):3–10.CrossRefPubMed
8.
Van Oyen H, Charafeddine R, Deboosere P, Cox B, Lorant V, Nusselder W, et al. Contribution of mortality and disability to the secular trend in health inequality at the turn of century in Belgium. Eur J Publ Health. 2011;21(6):781–7.CrossRef
9.
Renard F, Gadeyne S, Devleesschauwer B, Tafforeau J, Deboosere P. Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of death. J Epidemiol Community Health. 2017;71(4):371–80.
10.
Renard F, Deboosere P, Tafforeau J. Mapping the cause-specific premature mortality reveals large between-districts disparity in Belgium, 2003–2009. Archives Public Health 2015;73(1):13-doi:10.​1186/​s13690-015-0060-5.
11.
Van Houte-Minet M, Wunsch G. La mortalité Masculine aux âges adultes: causes et déterminants régionaux. Popul Famille. 1978;44(2):19–48.PubMed
12.
Van Houte-Minet M, Wunsch G. La mortalité masculine aux âges adultes, un essai d'analyse régionale. Popul Famille. 1978;43:37–68.PubMed
13.
Dooghe D. Gedifferentieerd sterftebeeld: toepassing U.Yule method. Popul Famille. 1965;6:211–29.
14.
Humblet P, Lagasse R, Moens G, Van de Voorde H, Wollast E. Atlas de la mortalité évitable en Belgique - Atlas van de vermijdbare strefte in België (1974–1978). School voor Maatschappelijke Gezondheidszorg: Brussels; 1986.
15.
Lagasse R, Humblet PC, Hooft P, Van de Voorde H, Wollast E. Atlas of avoidable mortality in Belgium 1980–1984. Arch Public Health. 1992;50:1–97.
16.
Leveque A, Humblet PC, Lagasse R. Atlas of avoidable mortality in Belgium 1985–1989. Arch Public Health. 1999;57:1–87.
17.
Renard F, Tafforeau J, Deboosere P. Premature mortality in Belgium in 1993–2009: leading causes, regional differences and 15 years changes. Arch Pub Health. 2014;72(1):34. doi:10.​1186/​2049-3258-72-34.CrossRef
18.
Deboosere P, Gadeyne S. Can regional patterns of mortality in Belgium e explained by individual socio-economic characteristics? Reflets et Perspectives de la vie économique. 2002;XII(4):87–103.CrossRef
19.
Van Hemelrijck WM, Willaert D, Gadeyne S. The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences? Arch Public Health. 2016;74:22.CrossRefPubMedPubMedCentral
20.
Deboosere P, Gadeyne S. De Nationale databank Mortaliteit. Aanmaak van een databank voor onderzoek van differentiële sterfte naar socio-economische status en leefvorm. Brussel: Steunpunt Demografie, Vakgroep Sociaal Onderzoek, Vrije Universiteit Brussel; 1999. Report No.: 1999–7
21.
Deboosere P, Gadeyne S. La sous-mortalité des immigrés adultes en Belgique: une réalité attestée par les recensements et les registres. Population. 2005;60(5–6):765–812.
22.
Anson J. The migrants mortality advantage: a 70 months follow up of the Brussels population. Eur J Popul. 2004;20:191–218.CrossRef
23.
UNESCO. International standard Classification of education, ISCED 1997. 1997.
24.
Vandenheede H, Lammens L, Deboosere P, Gadeyne S, De SM. Ethnic differences in diabetes-related mortality in the Brussels-capital region (2001–05): the role of socioeconomic position. Int J Public Health. 2011;56(5):533–9.CrossRefPubMed
25.
Deboosere P, Willaert D. Codeboek algemene socio-economic enquête 2001, Working paper: Steunpunt Demografie, Vakgroep Sociaal Ondezoek, Vrije Universiteir, Brussel; 2004.
26.
27.
WHO. International statistical Classification of diseases and related health problems: 10th revision. 1st ed. Geneva: World Health Organisation; 1994.
28.
29.
30.
Holland WW, Fitzgerald AP, Hildrey SJ, Philips SJ. Heaven can wait. J Public Health Med. 1994;16(3):321–30.PubMed
31.
Humblet PC, Lagasse R, Moens GFG, Wollast E, Van de Voorde H. La mortalité évitable en Belgique. Soc Sci Med. 1987;25:485–93.CrossRefPubMed
32.
Waterhouse J, Muir CS, Correa P, Powell J. Cancer incidence in five continents. IARC: Lyon; 1976.
33.
Armitage P, Berry G. Statistical methods in medical research. Oxford: Blackwell Scientific Publications; 1987.
34.
Smith P. Comparison between registries: age-standardized rates. In: Muir C, Waterhouse J, Mack T, Powell J, Whelan S, editors. Cancer incidence in five continents, volume V. Lyon: IARC; 1987. p. 790–5.
35.
Harper S, Lynch J. Methods for measuring cancer disparities:using data relevant to healthy people 2010 cancer-related objectives. Bethesda: National Cancer Institute: NIH Publication No. 05–5777; 2005.
36.
Harper S, King NB, Meersman SC, Reichman ME, Breen N, Lynch J. Implicit value judgments in the measurement of health inequalities. Milbank Q. 2010;88(1):4–29.CrossRefPubMedPubMedCentral
37.
Speybroeck N, Harper S, de Savigny D, Victora C. Inequalities of health indicators for policy makers: six hints. Int J Public Health. 2012;57(5):855–8.CrossRefPubMed
38.
Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757–71.CrossRefPubMed
39.
Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–57.CrossRefPubMed
40.
Robert C, Casella G. Monte Carlo statistical methods. New York: Springer Science & Business Media; 2004.CrossRef
41.
42.
Vandenheede H, Willaert D, De GH, Simoens S, Vanroelen C. Mortality in adult immigrants in the 2000s in Belgium: a test of the ‘healthy-migrant’ and the ‘migration-as-rapid-health-transition’ hypotheses. Tropical Med Int Health. 2015;20(12):1832–45.CrossRef
43.
Mackenbach JP, Kulhanova I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2015;69(3):207–17.CrossRefPubMed
44.
Mackenbach JP, Kulhanova I, Artnik B, Bopp M, Borrell C, Clemens T, et al. Changes in mortality inequalities over two decades: register based study of European countries. BMJ. 2016;353:i1732.CrossRefPubMedPubMedCentral
Metadata
Title
Educational inequalities in premature mortality by region in the Belgian population in the 2000s
Authors
Françoise Renard
Brecht Devleesschauwer
Sylvie Gadeyne
Jean Tafforeau
Patrick Deboosere
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2017
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-017-0212-x

Other articles of this Issue 1/2017

Archives of Public Health 1/2017 Go to the issue

Systematic review

Estimate of undergraduate university student alcohol use in China: a systematic review and meta-analysis

Research

Immunization dropout rate and data quality among children 12–23 months of age in Ghana

Research

Effect of sex and age on traumatic brain injury: a geographical comparative study

Commentary

An integrated and sustainable EU health information system: national public health institutes’ needs and possible benefits

Commentary

Brucellosis in livestock and wildlife: zoonotic diseases without pandemic potential in need of innovative one health approaches

Methodology

Getting started with tables