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Journal Article


Blakely T, Disney G, Atkinson J, Teng A, Mackenbach JP. Epidemiology 2017; 28(4): 594-603.


a. Department of Public Health, University of Otago, Wellington b. Department of Public Health, Erasmus MC, Rotterdam, Netherlands.


(Copyright © 2017, Lippincott Williams and Wilkins)






BACKGROUND: Holistic depiction of time-trends in average mortality rates, and absolute and relative inequalities, is challenging.

METHODS: We outline a typology for situations with falling average mortality rates (m↓; e.g. cardiovascular disease), rates stable over time (m-; e.g. some cancers), and increasing average mortality rates (m↑; e.g. suicide in some contexts). If we consider inequality trends on both the absolute (a) and relative (r) scales, there are 13 possible combination of m, a, and r trends over time. They can be mapped to graphs with relative inequality (log relative index of inequality (RII); r) on the y-axis, log average mortality rate on the x-axis (m), and absolute inequality (slope index of inequality; SII; a) as contour lines. We illustrate this by plotting adult mortality trends: (1) by household income from 1981 to 2011 for New Zealand, and (2) by education for European countries.

RESULTS: Types range from the 'best' m↓a↓r↓ (average, absolute, and relative inequalities all decreasing; southwest movement in graphs) to the 'worst' m↑a↑r↑ (northeast). Mortality typologies in New Zealand (all cause, cardiovascular disease, non-lung cancer, and unintentional injury) were all m↓r↑ (northwest), but variable with respect to absolute inequality. Most European typologies were m↓r↑ types (northwest; e.g. Finland), but with notable exceptions of m-a↑r↑ (north; e.g. Hungary) and 'best' or southwest m↓a↓r↓ for Spain (Barcelona) females.

CONCLUSION: Our typology and corresponding graphs provide a convenient way to summarize and understand past trends in inequalities in mortality, and hold potential for projecting future trends and target setting.

Language: en


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