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. 2015 Apr;105(4):e112-9.
doi: 10.2105/AJPH.2014.302344. Epub 2015 Feb 25.

The contribution of national disparities to international differences in mortality between the United States and 7 European countries

Karen van Hedel  1 , Mauricio Avendano, Lisa F Berkman, Matthias Bopp, Patrick Deboosere, Olle Lundberg, Pekka Martikainen, Gwenn Menvielle, Frank J van Lenthe, Johan P Mackenbach
Affiliations

The contribution of national disparities to international differences in mortality between the United States and 7 European countries

Karen van Hedel et al. Am J Public Health. 2015 Apr.

Abstract

Objectives: This study examined to what extent the higher mortality in the United States compared to many European countries is explained by larger social disparities within the United States. We estimated the expected US mortality if educational disparities in the United States were similar to those in 7 European countries.

Methods: Poisson models were used to quantify the association between education and mortality for men and women aged 30 to 74 years in the United States, Belgium, Denmark, Finland, France, Norway, Sweden, and Switzerland for the period 1989 to 2003. US data came from the National Health Interview Survey linked to the National Death Index and the European data came from censuses linked to national mortality registries.

Results: If people in the United States had the same distribution of education as their European counterparts, the US mortality disadvantage would be larger. However, if educational disparities in mortality within the United States equaled those within Europe, mortality differences between the United States and Europe would be reduced by 20% to 100%.

Conclusions: Larger educational disparities in mortality in the United States than in Europe partly explain why US adults have higher mortality than their European counterparts. Policies to reduce mortality among the lower educated will be necessary to bridge the mortality gap between the United States and European countries.

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Figures

FIGURE 1—
FIGURE 1—
Contribution of specific causes of death to the change in US mortality (dis)advantage for women: United States and 7 European Countries, 1989–2003. Note. Numbers in parentheses indicate absolute change in all-cause mortality.
See this image and copyright information in PMC

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