Contribution of mortality and disability to the secular trend in health inequality at the turn of the century in Belgium

Background: There is evidence that health inequalities by socio-economic status have persisted. We examined whether educational differences in Disability-Free Life Expectancy (DFLE) and Disability Life Expectancy (DLE) at age 25 has narrowed or widened between the 1990s and 2000s in Belgium. The contribution of mortality and disability prevalence to the secular trend is investigated. Methods: We used disability data from the 1997 and 2004 Belgian Health Interviews Surveys and mortality data from the 3-years follow-up of the 1991 and 2001 census population to assess education-related disparities in DFLE and DLE and to partition these differences into additive contributions of mortality and disability. Results: Compared to the highest educated population, differences in the prevalence of disability accounted for at least 66% of the inequality in DFLE. In the latest period, the differences in DFLE compared to men with tertiary education was 4.8, 6.6, 9.7 and 18.6 years for men with, respectively higher secondary, lower secondary, primary and no education. Among females, inequalities in DFLE were, respectively 5.8, 5.1, 10.8 and 18.2 years. There was no evidence that the educational differences in DFLE narrowed since the 1990s. Compared to people with the highest educational attainment, the inequalities in DFLE increased over time for all educational groups except for men with primary education. Conclusion: The social divide in health increased over time: people with the highest education continued to live even longer, they continued to live even longer without disability and to live less years with disability.