Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
Faculty of Medicine, University of Basel, Basel, Switzerland.
Int J Equity Health. 2023 Jul 28;22(1):140. doi: 10.1186/s12939-023-01958-8.
Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest.
DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries.
Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low.
The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.
尽管过去几十年的整体健康状况有所改善，但欧洲国家之间和内部仍存在着与非传染性疾病（NCDs）相关的健康不平等。缺乏研究深入了解欧洲经济区（EEA）国家与 NCD 相关的健康不平等。因此，本研究的目的是量化 30 个 EEA 国家在 NCD 总发病率和 12 种特定 NCD 发病率的标准化残疾调整生命年（DALY）率方面的健康不平等程度。此外，本研究旨在确定健康不平等的趋势，并确定那些 NCD 不平等程度最高的疾病。
通过性别和时间计算 DALY 率比来确定和比较 30 个 EEA 国家之间的不平等程度。使用年度变化率来确定 1990 年至 2019 年男性和女性 DALY 率之间的差异。基尼系数（GC）用于衡量国家间 DALY 率的不平等程度，斜率指数（SII）用于估计国家间 DALY 率的平均绝对差异。
1990 年至 2019 年，DALY 率呈总体下降趋势，女性的下降幅度大于男性。在 EEA 国家中，2019 年两性发病率最高的 NCD DALY 率是保加利亚。在整个研究期间，发病率最高的 DALY 率比见于消化疾病、糖尿病和肾脏疾病、物质使用障碍、心血管疾病（CVD）和慢性呼吸道疾病——这代表了国家间最高的不平等。2019 年，保加利亚和冰岛男性 DALY 率比最高。GC 和 SII 表明，在研究期间的大部分时间里，心血管疾病导致了最高的不平等——然而，总体不平等水平较低。
在所有国家中，一级 NCD DALY 率的不平等程度相对较低。心血管疾病、消化疾病、糖尿病和肾脏疾病、物质使用障碍以及慢性呼吸道疾病是 EEA 国家间表现出更高不平等水平的 NCD。通过应用有针对性的预防措施和提供医疗保健服务，可以缓解这一情况。
