Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a...

Reducing socio-economic health inequalities is a public health priority, necessitating careful monitoring that should take into account changes in the population composition. We analyzed the evolution of educational inequalities in life expectancy and disability-free life expectancy at age 25 (LE₂₅ and DFLE₂₅) in Belgium between 2001 and 2011.

The 2001 and 2011 census data were linked with the national register data for a five-year mortality follow up. Disability prevalence estimates from the health interview surveys (2001 to 2013) were used to compute DFLE according to Sullivan's method. LE₂₅ and DFLE₂₅ were computed by educational level (EL). Absolute differentials of LE₂₅ and DFLE₂₅ were calculated for each EL and for each period, as well as composite inequality indices (CII) of population-level impact of inequality. Changes over the 10-year period were then calculated for each inequality index.

The LE₂₅ increased in all ELs and both genders, except in the lowest EL for women. The increase was larger in the highest EL, leading in 2011 to 6.07 and 4.58 years for the low-versus-high LE₂₅ gaps respectively in men and women, compared to 5.19 and 3.76 in 2001, namely 17 and 22% increases. The upwards shift of the EL distribution led to a limited 7% increase of the CII among men but no change in women.The substantial increase of the DFLE₂₅ in males with high EL (+ 4.5 years) and the decrease of the DFLE₂₅ in women with low EL, results in a substantial increase of all considered DFLE₂₅ inequality measures in both genders. In 2011, DFLE₂₅ gaps were respectively 10.4 and 13.5 years in males and females compared to 6.51 and 9.30 in 2001, representing increases of 61 and 44% for the gaps, and 72 and 20% for the CII.

The LE₂₅ increased in all ELs, but at a higher pace in highly educated, leading to an increase in the LE₂₅ gaps in both genders. After accounting for the upwards shift of the educational distribution, the population-level inequality index increased only for men. The DFLE₂₅ increased only in highly educated men, and decreased in low educated women, leading to large increases of inequalities in both genders. A general plan to tackle health inequality should be set up, with particular efforts to improve the health of the low educated women.