Determinants of inequalities in years with disability: an international-comparative study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt


  • Wilma J Nusselder
  • José Rubio Valverde
  • Matthias Bopp
  • Brønnum-Hansen, Henrik
  • Patrick Deboosere
  • Ramune Kalediene
  • Katalin Kovács
  • Mall Leinsalu
  • Pekka Martikainen
  • Gwenn Menvielle
  • Enrique Regidor
  • Bodgan Wojtyniak
  • Johan P Mackenbach

BACKGROUND: Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father's manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption.

METHODS: We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010-14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated ('upward levelling scenario'), using Population Attributable Fractions.

RESULTS: Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father's manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small.

CONCLUSIONS: Disadvantages in material circumstances (low income), circumstances during childhood (father's manual occupation) and high body-weight contribute to inequalities in years with disability.

TidsskriftEuropean Journal of Public Health
Udgave nummer3
Sider (fra-til)527–533
Antal sider7
StatusUdgivet - 2021

Bibliografisk note

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.

ID: 252037921