Continued geographical disparities in premature mortality in Europe
Research findings
|Published
Despite declines in almost all subnational- regions in Europe, geographical disparities in premature mortality from all causes persist, both within and between countries of the EEA. The differences are linked to socio-economic factors. This is shown by a new study from researchers from the European Burden of Disease Network, co-led by a researcher at Norwegian Institute of Public Health.
The study is the first of its kind to examine premature all-cause mortality measured by age-adjusted and population-adjusted years of life lost, across subnational regions in all EEA countries before the COVID-19 pandemic. The EEA countries are members of the EU as well as the EFTA countries Iceland, Liechtenstein and Norway.
The study in Lancet Public Health:
Premature mortality, "years of life lost (YLL)", is a measure that is based on both the number of deaths and the age at which death occurs. In this way, the health status of the population can be compared across regions and countries. The background is that most premature deaths can be avoided through better prevention.
Fact box:
About years of life lost (YLL)
- YLL represents the gap between a person's age at death and standardised life expectancy.
- It quantifies the burden of premature mortality in a population.
- YLL takes into account both the frequency and the age distribution of deaths.
- YLL is used to inform policies aimed at reducing health inequalities.
- YLL is a key indicator in Global Burden of Disease (GBD) study, enabling comparative analyses across populations, time periods and geographic locations.
Higher YLL in regions of central and eastern Europe and lower in southern Europe
The study shows that more people die prematurely in central and eastern Europe, and that fewer die prematurely in southern Europe. In 2019, premature deaths were generally higher in most regions of central and eastern Europe for men and women, especially in Bulgaria, Romania, and Hungary. Similarly, lower premature deaths in men and women were observed in regions of southern Europe, such as Spain, Malta, and Italy.
The reduction in premature deaths from 2009 to 2019 was greatest in regions located in northern Europe, the Baltic States and Ireland
On the other hand, only modest reductions in premature deaths were observed in the study in major western European countries, such as France, Germany and the UK, as well as many regions of southern Europe.
- The decrease can most likely be explained by a general reduction in cardiovascular-related deaths, with a flattening of progress in recent years, says Baravelli.
Stronger associations with socioeconomic factors in central and eastern Europe and southern Europe
Across all major regions in the EEA, socio-economic factors such as household income, risk of poverty, and level of education were generally associated with variations in premature deaths.
These associations were generally stronger in central and eastern Europe and southern Europe.
- Interestingly, the strength of the association was weaker and less clear in northern Europe, with associations only identified for educational attainment among men. This contrasts with previous research which has suggested stronger socio-economic inequalities in northern Europe and weaker in southern Europe, says Baravelli.
The study sheds light on the geographical and socio-economic inequalities in premature deaths and provides valuable insights for decision-makers.
- By understanding and addressing these inequalities at both national, regional, and the local level, we can better target measures and allocate resources to the regions most at need. Tailored regional guidelines are essential for reducing health inequalities and promoting regional development, in line with the objectives of the EU's cohesion policy, concludes Baravelli.
Weaknesses of the study
The biggest weakness of the study is that an ecological study design has been used. This means that the researchers correlate the social characteristics of very large groups of people over large geographical areas with premature mortality. Therefore, it is important that conclusions about individuals are not drawn based on these group-level data. For example, there are very large differences between people living in a single county, and the study did not take this heterogeneity into account.
The researchers obtained mortality and population data from Eurostat, legislated under EU law, which relies on robust vital registration systems in European countries. Some data were missing for some countries in 2019, and these values were therefore calculated using robust methods and time series data from previous years.
