• Johan P Mackenbach, Ivana Kulhánová, Barbara Artnik, Matthias Bopp, Carme Borrell, Tom Clemens, Giuseppe Costa, Chris Dibben, Ramune Kalediene, Olle Lundberg, Pekka Martikainen, Gwenn Menvielle, Olof Östergren, Remigijus Prochorskas, Maica Rodríguez-Sanz, Bjørn Heine Strand, Caspar W N Looman, and Rianne de Gelder.
• Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands j.mackenbach@erasmusmc.nl.
• BMJ. 2016 Apr 11; 353: i1732.

ObjectiveTo determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.DesignRegister based study.Data SourceMortality 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).SettingAll 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.ResultsSubstantial 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.ConclusionsOver 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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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