Cavelaars A E, Kunst A E, Geurts J J, Crialesi R, Grötvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Mizrahi A, Mizrahi A, Rasmussen N K, Regidor E, Spuhler T, Mackenbach J P
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
J Epidemiol Community Health. 1998 Apr;52(4):219-27. doi: 10.1136/jech.52.4.219.
To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels.
National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality.
The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator.
Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.
评估11个西欧国家中，高学历人群与低学历人群自我报告的发病率差异大小是否存在不同。
关于按教育水平划分的发病率的全国代表性数据，来自1985年至1993年间开展的健康访谈调查、生活水平调查或其他类似调查。纳入了四项发病率指标，并做出了相当大的努力以使这些指标具有最大可比性。对每项调查都应用了标准化的教育水平方案。该研究涵盖了年龄在25至69岁之间的男性和女性。发病率差异大小通过基于回归的不平等相对指数来衡量。
发现各国健康不平等的程度有所不同。总体而言，瑞典、挪威和丹麦的不平等程度往往相对较大，而西班牙、瑞士和西德的不平等程度相对较小。芬兰、英国、法国和意大利处于中间位置。荷兰的情况因性别差异很大：男性的不平等程度相对较大，而女性的不平等程度相对较小。一些国家（如西德）的相对位置根据发病率指标而有所不同。
由于数据的准确性和国际可比性存在一些未解决的问题，不平等估计的不确定性范围有点宽。然而，这些问题不太可能解释总体模式。值得注意的是，在荷兰和斯堪的纳维亚国家等实行更平等政策的国家，健康不平等不一定更小。文中讨论了可能的解释。
