TY - JOUR

T1 - Educational differentials in disability vary across and within welfare regimes

T2 - a comparison of 26 European countries in 2009

AU - Cambois, Emmanuelle

AU - Solé-Auró, Aïda

AU - Brønnum-Hansen, Henrik

AU - Egidi, Viviana

AU - Jagger, Carol

AU - Jeune, Bernard

AU - Nusselder, Wilma J

AU - Van Oyen, Herman

AU - White, Chris

AU - Robine, Jean-Marie

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes.METHODS: Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups.RESULTS: The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups.CONCLUSIONS: The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.

AB - BACKGROUND: Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes.METHODS: Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups.RESULTS: The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups.CONCLUSIONS: The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.

U2 - 10.1136/jech-2015-205978

DO - 10.1136/jech-2015-205978

M3 - Journal article

C2 - 26546286

VL - 70

SP - 331

EP - 338

JO - Journal of Epidemiology & Community Health

JF - Journal of Epidemiology & Community Health

SN - 0143-005X

IS - 4

ER -