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 ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Socioeconomic hierarchy and health gradient in Europe: the role of income inequality and of social origins

Authors: Louis Chauvel, Anja K. Leist

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

Health inequalities reflect multidimensional inequality (income, education, and other indicators of socioeconomic position) and vary across countries and welfare regimes. To which extent there is intergenerational transmission of health via parental socioeconomic status has rarely been investigated in comparative perspective. The study sought to explore if different measures of stratification produce the same health gradient and to which extent health gradients of income and of social origins vary with level of living and income inequality.

Methods

A total of 299,770 observations were available from 18 countries assessed in EU-SILC 2005 and 2011 data, which contain information on social origins. Income inequality (Gini) and level of living were calculated from EU-SILC. Logit rank transformation provided normalized inequalities and distributions of income and social origins up to the extremes of the distribution and was used to investigate net comparable health gradients in detail. Multilevel random-slope models were run to post-estimate best linear unbiased predictors (BLUPs) and related standard deviations of residual intercepts (median health) and slopes (income-health gradients) per country and survey year.

Results

Health gradients varied across different measures of stratification, with origins and income producing significant slopes after controls. Income inequality was associated with worse average health, but income inequality and steepness of the health gradient were only marginally associated.

Conclusions

Linear health gradients suggest gains in health per rank of income and of origins even at the very extremes of the distribution. Intergenerational transmission of status gains in importance in countries with higher income inequality. Countries differ in the association of income inequality and income-related health gradient, and low income inequality may mask health problems of vulnerable individuals with low status. Not only income inequality, but other country characteristics such as familial orientation play a considerable role in explaining steepness of the health gradient.
Appendix
Available only for authorised users
Literature
1.
Geyer S, Hemström Ö, Peter R, Vågerö D. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health. 2006;60:804–10.PubMedCentralCrossRefPubMed
2.
Torssander J, Erikson R. Stratification and mortality—a comparison of education, class, status, and income. Eur Sociol Rev. 2010;26:465–74.CrossRef
3.
Chauvel L, Leist AK. Social epidemiology. In: Wright JD, editor. International encyclopedia of the social & behavioral sciences. 2nd ed. Oxford: Elsevier; 2015. p. 275–81.CrossRef
4.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;80–94.
5.
Beckfield J, Olafsdottir S. Empowering health: a comparative political sociology of health disparities. Message from the Chair of the Council for European Studies 2009:9
6.
Laaksonen M, Rahkonen O, Martikainen P, Lahelma E. Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health. 2005;95:1403–9.PubMedCentralCrossRefPubMed
7.
Osler M, Madsen M, Nybo Andersen A-M, et al. Do childhood and adult socioeconomic circumstances influence health and physical function in middle-age? Soc Sci Med. 2009;68:1425–31.PubMedCentralCrossRefPubMed
8.
Hyde M, Jakub H, Melchior M, Van Oort F, Weyers S. Comparison of the effects of low childhood socioeconomic position and low adulthood socioeconomic position on self rated health in four European studies. J Epidemiol Community Health. 2006;60:882–6.PubMedCentralCrossRefPubMed
9.
Wilkinson R, Pickett K. The spirit level. Why equality is better for everyone. London: Penguin; 2010.
10.
11.
12.
Babones SJ. Income inequality and population health: correlation and causality. Soc Sci Med. 2008;66:1614–26.CrossRefPubMed
13.
López-Casasnovas G, Soley-Bori M. The socioeconomic determinants of health: economic growth and health in the OECD countries during the last three decades. Int J Environ Res Public Health. 2014;11:815–29.PubMedCentralCrossRefPubMed
14.
Semyonov M, Lewin-Epstein N, Maskileyson D. Where wealth matters more for health: the wealth–health gradient in 16 countries. Soc Sci Med. 2013;81:10–7.CrossRefPubMed
15.
Brennenstuhl S, Quesnel-Vallée A, McDonough P. Welfare regimes, population health and health inequalities: a research synthesis. J Epidemiol Community Health. 2012;66:397–409.CrossRefPubMed
16.
Bergqvist K, Yngwe MÅ, Lundberg O. Understanding the role of welfare state characteristics for health and inequalities-an analytical review. BMC Public Health. 2013;13:1234.PubMedCentralCrossRefPubMed
17.
Cantarero D, Pascual M, María Sarabia J. Effects of income inequality on population health: new evidence from the European Community Household Panel. Appl Econ. 2005;37:87–91.CrossRef
18.
Van Ourti T, van Doorslaer E, Koolman X. The effect of income growth and inequality on health inequality: theory and empirical evidence from the European Panel. J Health Econ. 2009;28:525–39.CrossRefPubMed
19.
Poulton R, Caspi A, Milne BJ, et al. Association between children’s experience of socioeconomic disadvantage and adult health: a life-course study. Lancet. 2002;360:1640–5.PubMedCentralCrossRefPubMed
20.
Cohen S, Janicki-Deverts D, Chen E, Matthews KA. Childhood socioeconomic status and adult health. Ann N Y Acad Sci. 2010;1186:37–55.CrossRefPubMed
21.
Whelan CT, Nolan B, Maître B. Analysing intergenerational influences on income poverty and economic vulnerability with EU-SILC. Eur Soc. 2013;15:82–105.CrossRef
22.
ABG: Stata module to implement the Alpha-Beta-Gamma Method of Distributional Analysis [computer program] Boston College Department of Economics, 2014.
23.
Chauvel L. The intensity and shape of inequality: the ABG method of distributional analysis. Rev Income Wealth. 2015.
24.
Rotman A, Shavit Y, Shalev M. Nominal and positional perspectives on educational stratification in Israel. Research in Social Stratification and Mobility, in press.
25.
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;44:757–71.CrossRefPubMed
26.
Singh-Manoux A, Dugravot A, Shipley MJ, et al. The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study. Int J Epidemiol. 2007;36:1222–8.PubMedCentralCrossRefPubMed
27.
Hill J, Gelman A. Data analysis using regression and multilevel/hierarchical models. Cambridge University Press; 2007
28.
Elo IT. Social class differentials in health and mortality: patterns and explanations in comparative perspective. Annu Rev Sociol. 2009;35:553–72.CrossRef
29.
Chiavegatto Filho ADP, Lebrão ML, Kawachi I. Income inequality and elderly self-rated health in São Paulo, Brazil. Ann Epidemiol. 2012;22:863–7.CrossRefPubMed
30.
Hernández-Quevedo C, Jones AM, López-Nicolás A, Rice N. Socioeconomic inequalities in health: a comparative longitudinal analysis using the European Community Household Panel. Soc Sci Med. 2006;63:1246–61.CrossRefPubMed
31.
Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian S, Yamagata Z. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ. 2009;339:b4471.PubMedCentralCrossRefPubMed
32.
Pickett KE, Wilkinson RG. Income inequality and health: a causal review. Soc Sci Med. 2015;128:316–26.CrossRefPubMed
33.
Conroy K, Sandel M, Zuckerman B. Poverty grown up: how childhood socioeconomic status impacts adult health. J Dev Behav Pediatr. 2010;31:154–60.CrossRefPubMed
34.
Beckfield J, Olafsdottir S, Bakhtiari E. Health inequalities in global context. Am Behav Sci. 2013;57:1014–39.CrossRef
35.
36.
Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75:761–9.CrossRefPubMed
37.
Eikemo TA, Huisman M, Bambra C, Kunst AE. Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn. 2008;30:565–82.CrossRefPubMed
38.
Eikemo TA, Bambra C, Judge K, Ringdal K. Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis. Soc Sci Med. 2008;66:2281–95.CrossRefPubMed
39.
Bambra C, Netuveli G, Eikemo TA. Welfare state regime life courses: the development of western European welfare state regimes and age-related patterns of educational inequalities in self-reported health. Int J Health Serv. 2010;40:399–420.CrossRefPubMed
40.
Avendano M, Glymour MM, Banks J, Mackenbach JP. Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health. 2009;99:540–8.PubMedCentralCrossRefPubMed
41.
Foubert J, Levecque K, Van Rossem R, Romagnoli A. Do welfare regimes influence the association between disability and self-perceived health? A multilevel analysis of 57 countries. Soc Sci Med. 2014;117:10–7.CrossRefPubMed
42.
Beckfield J, Krieger N. Epi + demos + cracy: linking political systems and priorities to the magnitude of health inequities—evidence, gaps, and a research agenda. Epidemiologic reviews 2009:mxp002.
43.
Gesthuizen M, Huijts T, Kraaykamp G. Explaining health marginalisation of the lower educated: the role of cross‐national variations in health expenditure and labour market conditions. Sociol Health Illn. 2012;34:591–607.CrossRefPubMed
44.
Maskileyson D. Healthcare system and the wealth–health gradient: a comparative study of older populations in six countries. Soc Sci Med. 2014;119:18–26.CrossRefPubMed
45.
Dahl E, van der Wel KA. Educational inequalities in health in European welfare states: a social expenditure approach. Soc Sci Med. 2013;81:60–9.CrossRefPubMed
46.
Mackenbach JP, McKee M. A comparative analysis of health policy performance in 43 European countries. Eur J Public Health. 2013;23:195–201.CrossRefPubMed
47.
Krieger N, Williams DR, Moss NE. Measuring social class in U.S. public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341.CrossRefPubMed
48.
d’Uva TB, O’Donnell O, van Doorslaer E. Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. Int J Epidemiol. 2008;37:1375–83.CrossRefPubMed
49.
Metadata
Title
Socioeconomic hierarchy and health gradient in Europe: the role of income inequality and of social origins
Authors
Louis Chauvel
Anja K. Leist
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0263-y

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Research

Trends and outcomes in the utilization of laparoscopic appendectomies in a low-income population in Taiwan from 2003 to 2011

Research

Paving the way for universal family planning coverage in Ethiopia: an analysis of wealth related inequality

Research

The influence of socioeconomic status on future risk for developing Type 2 diabetes in the Canadian population between 2011 and 2022: differential associations by sex

Research Article

Income-related inequalities in health care utilization in Mongolia, 2007/2008–2012

Reviewer acknowledgement

Acknowledgement of manuscript reviewers 2014

Erratum

Erratum: Lessons from sexual and reproductive health voucher program design and function: a comprehensive review