Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.

中文翻译：

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应对死亡率不平等的进展：1990年至2015年间基于登记册的15个欧洲国家的研究

死亡率的社会经济不平等是全世界公共卫生面临的挑战，但似乎对决策产生了抵制。我们的目标是确定在缩小死亡率不平等以及与缩小不平等相关的因素上比其他国家更成功的欧洲国家。我们在过去25年中按教育水平收集并统一了死亡率数据，在15个欧洲国家中进行了统计，并使用一系列衡量不平等现象的方法（例如“相对”和“绝对”不平等， “成就”和“不足”）。我们确定了导致不平等现象缩小的死亡原因，并进行了国家和期间固定影响分析，以评估哪些国家级因素与死亡率不平等的缩小相关。在所有欧洲国家中，低学历者的死亡率都在迅速下降，而且在许多国家中，绝对不平等现象有所缩小，但相对差距并未缩小。表现最佳的是男性中的奥地利，意大利（都灵）和瑞士，以及西班牙（巴塞罗那），英格兰和威尔士，以及女性中的奥地利。缺血性心脏病，与吸烟有关的原因（男性）和适当的原因通常助长了不平等现象的缩小。收入不平等，民主水平和吸烟的趋势与不平等加剧有关，但医疗保健支出的增加与不平等程度缩小有关。死亡率不平等的趋势并没有像通常所说的那样不利。