Details

Last Updated: 26 August 2024

• mental health
• suicide

1. Key messages

2. Background

3. Results

Situation in 2018

Trends

• The age-adjusted prevalence has increased in all ELs from 2008 to 2018.
• The absolute inequalities have increased between 2008 and 2013 then stayed stable.
• The relative inequalities have slightly and non-significantly decreased from 2004 to 2018. 

• The age-adjusted prevalence has increased in all ELs from 2004 to 2013 and then decreased in 2018.
• The absolute inequalities have increased between 2008 and 2013 then stayed stable.
• The relative inequalities have decreased from 2004 to 2013 then increased in 2018. This can be attributed to a smaller proportional decrease of the prevalence of depressive disorders in the low than in the high EL.

4. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Percentage-point

The Percentage-point (ppt) is the arithmetic difference between two percentages, for instance with 16% in group A and 8% in group B, the difference is 8 ppt, corresponding to a relative excess of 100%.

References

1. Mackenbach J. Health inequalities: Europe in profile. Expert Report commissioned by the EU. Department of Health Publications; 2006.
2. Feinstein JS. The relationship between socioeconomic status and health : A review of the literature. The Milkbank Quarterly. 1993
3. WHO Commission on Social Determinants on Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO; 2008.
4. Executive Agency for Health and Consumer. Second Programme of Community Action in the Field of Health 2008-2013. European Commission; 2007.
5. Vlaamse overheid. Vlaamse Actieplan Geestelijke Gezondheid, Strategisch plan 2017-2019. 2017.
6. Gouvernement wallon. Plan prévention et promotion de la santé en Wallonie. Partie 1: définition des priorités en santé. Namur; 2017. 
7. Arrêté royal du 18 juillet 2013 portant fixation de la vision stratégique fédérale à long terme de développement durable: http://www.etaamb.be/fr/arrete-royal-du-18-juillet-2013_n2013011468.html. Moniteur Belge. 2013 Oct 8;
8. Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. JHealth PopulNutr. 2003
9. Maeseneer JD, Willems S. Terugdringen Sociale Gezondheidskloof: van concept naar politieke implementatie. Ghent University; 2021
10. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Health Inequalities: Inequalities in mental health, Health Status Report, 14 Feb 2022, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/health-inequalities/inequalities-in-mental-health 

Details

Last Updated: 26 August 2024

• diabetes
• cardiovascular diseases
• musculoskeletal disorders
• respiratory diseases

1. Key messages

2. Background

• The absolute difference, which is the difference between the age-adjusted prevalence rates in the low versus the high ELs,
• The relative difference (Rate Ratio), which is the ratio of the age-adjusted prevalence rates in the low versus the high ELs,
• The Population Attributable Fraction (PAF), i.e. the percentage of gain in health expected in the whole population if all groups experienced the health of the most educated group.

3. Results

Situation in 2018

• large for AMI (in 65+) and COPD (in 65+), with respectively 2.0 and 1.9 times more people suffering from AMI (65+) and COPD (65+) in the low than the high EL group;
• moderate (between 1.4 and 1.6) for urinary incontinence (65+), migraine-like headache, diabetes, and asthma;
• small (between 1.1 and 1.3) for osteoarthritis, and high blood pressure. 

Trends

• Inequalities indicators for urinary incontinence (65+), IMA (65+), high blood pressure and osteoarthritis have no notable trends.
• The age-adjusted prevalence of migraine-like headache was stable between 2004-2013 and increased in 2018. The rate difference significantly decreased between 2001 and 2008, but then increased in 2013 and 2018 (increase not significant), with a same evolution observed for the relative inequalities (statistically not significant). So an increase (not significant) in inequalities is observed in migraine-like headache in the last period.
• The age-adjusted prevalence of COPD (65+) decreased from 2001 to 2018, with variable evolutions by EL. The inequalities in COPD prevalence (measured both with rate difference and rate ratio) decreased between 2008 and 2018.
• The age-adjusted prevalence of diabetes has increased in all EL groups since 1997, with a small stagnation in 2008. Qua inequalities, the low-versus-high absolute difference in rates remained stable since 2008 at a high level; the relative difference has decreased since 2008, reflecting a smaller proportional increase of the prevalence of diabetes in the low than in high EL. So, even if the RR has decreased in 2018, the global evolution of inequality for diabetes is still disappointing: indeed, it is important to obtain a reduction in absolute inequalities, which would require a more favorable evolution of the prevalence of diabetes in the socially disadvantaged group than in the advantaged group.
• The age-adjusted prevalence of asthma was stable until 2013 and increased in 2018. The inequalities in asthma have increased from 2001 to 2013 (measured as rate difference and rate ratio) and decreased in 2018.

4. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Percentage-point

The Percentage-point (ppt) is the arithmetic difference between two percentages, for instance with 16% in group A and 8% in group B, the difference is 8 ppt, corresponding to a relative excess of 100%.

Multimorbidity

The occurrence of at least 2 of the following diseases: chronic lung disease, heart disease, hypertension, diabetes, cancer, and arthropathy.

References

1. Mackenbach J. Health inequalities: Europe in profile. Expert Report commissioned by the EU. Department of Health Publications; 2006.
2. Feinstein JS. The relationship between socioeconomic status and health : A review of the literature. The Milkbank Quarterly. 1993
3. WHO Commission on Social Determinants on Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO; 2008.
4. Executive Agency for Health and Consumer. Second Programme of Community Action in the Field of Health 2008-2013. European Commission; 2007.
5. Vlaamse overheid. Vlaamse Actieplan Geestelijke Gezondheid, Strategisch plan 2017-2019. 2017.
6. Gouvernement wallon. Plan prévention et promotion de la santé en Wallonie. Partie 1: définition des priorités en santé. Namur; 2017. 
7. Arrêté royal du 18 juillet 2013 portant fixation de la vision stratégique fédérale à long terme de développement durable: http://www.etaamb.be/fr/arrete-royal-du-18-juillet-2013_n2013011468.html. Moniteur Belge. 2013 Oct 8;
8. Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. JHealth PopulNutr. 2003
9. Maeseneer JD, Willems S. Terugdringen Sociale Gezondheidskloof: van concept naar politieke implementatie. Ghent University; 2021
10. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Health Inequalities: Inequalities in non communicable diseases, Health Status Report, 14 Feb 2022, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/health-inequalities/inequalities-in-non-communicable-diseases 

Details

Last Updated: 03 July 2024

1. Key messages

2. Background

Socio-economic (SE) health inequalities refer to systematic disparities in health between SE groups, most often in disfavour of social groups lower on the social scale. SE health inequalities have been consistently observed throughout industrialized societies for the whole scope of health topics, ranging from health determinants to mortality [1;2]. Tackling health inequalities is a priority for the WHO [3], the European Union [4], and for Belgium [5-7]. In order to assess progress towards reducing health inequalities, it is important to measure and monitor them [8, 9].

SE inequalities can be calculated using different socio-economic markers, for instance, income level, educational level, occupation, or a multi-dimensional score combining several SE indicators. SE inequalities can be expressed in terms of absolute difference (here, the difference in mortality rates between the lowest and the highest advantaged group) or relative difference (here, the ratio of the mortality rates of the extreme groups). Methodological details are provided in this annexe.

Besides mortality rates by socio-economic groups, we also examined excess mortality rates to assess inequalities. Excess in mortality during the COVID-19 crisis compared to a reference mortality rate (e.g. the average mortality rate over the 5 previous years) can be expressed in absolute terms (as the difference in mortality rates between the COVID-19 period and the baseline period, here 2015-2019) or in relative terms, with a “p-score” (defined as the excess mortality rates divided by the baseline mortality rate). Several studies have described recent inequalities in all-cause mortality [10–12]. Results presented here mostly originate from the study of Decoster et al [11] and highlight the changes in income inequalities in mortality during the COVID-19 crisis. Inequalities in cause-specific mortality originate from previous studies [13,14].

3. Results

Inequalities in all-cause mortality

Inequalities by income

During the period 2015-2019

A strong income gradient in mortality was observed [11] in the pre-COVID-19 period (2015-2019).

For men aged 40-64 years, the absolute inequalities gradient in mortality, measured with the slope index of inequality (SII), reached 185 per 100,000 person-year, meaning that the mortality rate in the lowest income level exceeds the mortality rates of the highest income level by 185 per 100,000 person-year. The relative inequality, measured with the Relative Index of Inequality (RII), reached 5.3, meaning that the mortality rate (in this age group) was 5.3 times higher in the lowest than in the highest income level. For women aged 40-64 years, inequalities, although slightly smaller than in men, remained quite high, with the SII reaching 93 per 100,000 and the RII 3.9.

For men aged 65+, the absolute SII reached 596 per 100,000 person-year, with a RII of 1.76. For women aged 65+, the SII reached 499 per 100,000 person-year, with a RII of 2.05.

During the first wave of the COVID-19 crisis (March-May 2020)

The impact of the first wave of COVID-19 on inequalities in mortality depends on age groups.

For men and women aged 40-64 years, the mortality rates observed during the first COVID-19 wave did not change for all income groups compared with previous years, so inequalities did not change.

On the contrary, for men and women aged 65+, mortality rates increased significantly during the COVID-19 months for all income groups. This mortality jump was unequally distributed among income groups: in absolute terms, mortality rates increased more in the lowest (excess mortality of +350 per 100,000 person-year) than in the highest income level (excess mortality +150 per 100,000 person-year). At the same time, the relative excess mortality (that is the excess mortality in the studied year divided by the baseline mortality, or “P-score”) was rather similar across the different income levels, so no significant gradient could be observed. This smoother effect of unequal mortality change on relative than on absolute inequalities is expected when mortality is on the rise: indeed the proportional change is less affected by an increase in mortality rate in groups where mortality is high than in groups with a lower mortality rate.

This led to an increase of the SII, which jumped to respectively 791 and 672 per 100,000 person-year in men and women aged 65+. The increase in the RII was more modest, passing from 1.76 to 1.86 in men and from 2.05 to 2.31 in women.

Other socio-economic determinants

In this section, we present results highlighting the changes observed during the first wave of the COVID-19 crisis (compared to previous years) in all-cause mortality inequalities according to other SE determinants.

For the 2011-2015 period, inequalities in all-cause mortality according to several SE determinants have been calculated by Aerden et al. and summarized as inequalities in life expectancy [10].

Change in inequalities by educational level, first COVID-19 wave (March-May 2020)

According to Decoster et al. [11], educational inequalities in mortality among people younger than 65 years, similarly to income inequality, remained unchanged during the COVID-19 pandemic.

For people aged 65+, the well-known negative educational gradient in mortality became stronger during the COVID-19 crisis and the change was even more pronounced than for the income gradient. The increase in educational inequalities was observed for both absolute and relative inequalities.

Change in inequalities by a multi-dimensional indicator, first two COVID-19 waves (March-May & October-November 2020)

Bourguignon et al. [12] looked at the relationship between excess mortality among the 80+ and a multi-dimensional SE status during the first two COVID-19 waves; she came to a different conclusion for people aged 80+ than for younger people, with a larger mortality increase in the advantaged than in the disadvantaged group. This observation might partly result from a health selection effect – hypothesizing that people in the lowest SE group who have reached older age are less vulnerable, resulting consequently in a reduction or even an inversion of health inequality – and partly because people with an undetermined SE status presented the highest mortality rate and are likely to pertain to the most disadvantaged group.

Inequalities in cause-specific mortality

During the period 2011-2015

A study by Eggerickx et al. [14] presents inequalities by groups of cause of death (COD) and age in the period 2011-2015, expressed as the ratio of the probability of dying in the different SE groups (those groups are derived from a multi-dimensional SE score distributed in quartiles) as compared to the highest SE group. This is a relative measure of inequality.

For each COD group and at each age, a social gradient in the mortality risk is observed: the higher the social group, the lower the risk of dying. The relative SE inequalities by COD groups were the highest for diseases linked to the respiratory system and the circulatory system.

The relative SE inequalities in mortality decrease with age. A health selection effect – hypothesizing that people in the lowest SE group who have reached older age are less vulnerable, reducing mortality inequality – might play a role. The age pattern in absolute and relative inequalities can partly be explained by the small number of deaths at young ages in both groups, which would always yield a small absolute difference, but might yield a large relative difference.

Contribution of specific causes of deaths to the inequality in premature mortality, period 2001-2006

A previous study by Renard et al. [13] examined the contribution of specific causes of deaths to the total inequality in mortality below 75 years at the level of the population. The contribution was highest in men for lung cancer, ischemic heart diseases, suicide and chronic obstructive pulmonary diseases (COPD); in women, the contribution of ischemic heart disease, lung cancer, cerebrovascular diseases and COPD was highest. This points out the causes of deaths for which the reduction in inequality would most benefit the whole population, by reducing the global premature mortality level.

4. Read more

View the metadata for this indicator

References

1. Mackenbach J. Health inequalities: Europe in profile. Expert Report commissioned by the EU. Department of Health Publications; 2006 p.
2. Feinstein JS. The relationship between socioeconomic status and health : A review of the literature. The Milkbank Quarterly. 1993.
3. WHO Commission on Social Determinants on Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO; 2008.
4. Executive Agency for Health and Consumer. Second Programme of Community Action in the Field of Health 2008-2013. European Commission; 2007.
5. Vlaamse overheid. Vlaamse Actieplan Geestelijke Gezondheid, Strategisch plan 2017-2019. 2017.
6. Gouvernement wallon. Plan prévention et promotion de la santé en Wallonie. Partie 1: définition des priorités en santé. Namur; 2017. 
7. Arrêté royal du 18 juillet 2013 portant fixation de la vision stratégique fédérale à long terme de développement durable: http://www.etaamb.be/fr/arrete-royal-du-18-juillet-2013_n2013011468.html. Moniteur Belge. 2013 Oct 8;
8. Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. JHealth PopulNutr. 2003.
9. Maeseneer JD, Willems S. Terugdringen Sociale Gezondheidskloof: van concept naar politieke implementatie. Gent: Ghent University; 2021.
10. Aerden KV, Damiens J, Moortel DD, Eggerickx T, Gourbin C, Huegaerts K, et al. Causes of health and mortality inequalities in Belgium: multiple dimensions, multiple causes. 
11. Decoster A, Minten T, Spinnewijn J. The Income Gradient in Mortality during the Covid-19 Crisis: Evidence from Belgium. J Econ Inequal. 2021.
12. Bourguignon M, Damiens J, Doignon Y, Eggerickx T, Fontaine S, Lusyne P, et al. Variations spatiales et sociodémographiques de mortalité de 2020-2021 en Belgique. L’effet de la pandémie Covid-19, Document de travail 27. Louvain-la-Neuve: Centre de recherche en démographie; 2021.
13. Renard F, Tafforeau J, Deboosere P. Premature mortality in Belgium in 1993-2009: leading causes and 15 years changes. 2014. doi: 10.1186/2049-3258-72-34
14. Eggerickx T, Sanderson J-P, Vandeschrick C. Mortality in Belgium from nineteenth century to today: Quetelet Journal. 2020. 

Please cite this page as: Sciensano. Health Inequalities: Inequalities in mortality, Health Status Report, 14 Feb 2022, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/health-inequalities/inequalities-in-mortality 

Details

Last Updated: 12 August 2024

• life expectancy