Evolution of social and regional inequalities in mortality among young adults in Belgium between the 1990s and the 2000s

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Samenvatting

Background. This study addresses the evolution in regional and social inequalities in mortality among adolescents and young adults in Belgium. Social inequalities in mortality are of major concern to public health but are rarely studied at young ages. Most premature mortality of young adults results from preventable causes with strong social gradients, such as suicides, motor vehicle accidents and other injuries. Public-health policies intervening in these life stages are a prerequisite for giving children and adolescents a healthy start in life. Substantial health differences have been found between the Flemish (FR) and Walloon (WR) region measured in life expectancy, but little is known about regional differentials in mortality at young ages. Comparisons with the Brussels-Capital Region (BCR) also remain scarce.
Methods. Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on death and emigration in the periods of 01/10/1991-01/01/1996 and 01/10/2001-01/01/2006. The analysis was restricted to adolescents and young adults aged 15-34 years at the moment of each census. Absolute (directly standardized mortality rates) and relative (mortality rate ratio using Poisson regression) measures were calculated.
Results. There was a significant drop in young-adult male mortality between the 1990s and the 2000s in all regions, with the strongest decline in BCR (ASMR from 44.9 [95% CI 41.8-48.0] to 27.0 [95% CI 24.5-29.4]). The mortality rate remains highest in the WR (ASMR 41.1 [95% CI 39.4-42.7]). Declines in mortality among women were smaller and regional differences are less pronounced (ASMR 2001, FR: 11.8 [95% CI 11.1-12.5], BCR: 12.1 [95% CI 10.5-13.7], WR: 14.8 [95% CI 13.8-15.8]). There are considerable regional differences in the evolution of social inequalities. While there is a significant drop in almost all educational groups in BCR and WR, in FR this decline is only apparent among the highest educational groups, leading to higher relative inequalities, amongst both men and women.
Conclusions. There is a positive evolution towards lower mortality among the young. Social inequalities however remain substantial and even increased over time in FR. Efforts to lower these inequalities have to start at an early age.

Main message 1: In less than two decades, young-adult mortality dropped considerably in all Belgian regions and almost halved among men in the Brussels-Capital Region.
Main message 2: Although young-adult mortality dropped in almost all educational groups in the Brussels-Capital and Walloon Region, social inequalities increased among men and women in the Flemish region.
Originele taal-2English
TitelPaper presented at the European Public Health Conference (EUPHA)
Plaats van productieBrussels, Belgium
Pagina's189
Aantal pagina's1
StatusPublished - okt 2013

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