Deathly inequalities: highlighting trends at different ages

Author: Marlies Bär, PhD Candidate
Alena Darmel - Pexels

People living in poor areas are generally more likely to die earlier than those in wealthier areas. Recent reductions in mortality may have narrowed the gap if they were larger among poorer groups. However, in a recent study, we show that this depends on who we look at.

Most people seek to live a long life. Reality is that the chances of achieving that are not the same for everyone. From recent research we know that disadvantaged groups live shorter lives, and that such inequalities in longevity have increased over time. But, as Jawa Issa explained in an earlier blogpost, a summary measure like life expectancy does not reveal differential inequality patterns across different age-groups. That is, mortality inequalities may have evolved differently at different ages.

Take-home messages

  • We find that improvements in mortality were larger among the poor in younger age-groups, decreasing inequalities at these ages;
  • In contrast, mortality inequalities increased at older ages due to larger drops in mortality among the rich;
  • When studying poverty related inequalities in longevity, researchers and policymakers need to focus on mortality at different ages to obtain a more comprehensive picture.

Who, where and how?

Our study includes the total population of the Netherlands between 1996 and 2016. By dividing them into groups based on the poverty level of their municipality, we examine whether reductions in mortality were larger among certain poverty groups. We conduct this exercise for six different age-groups by gender. From this, we draw conclusions about how recent drops in mortality shaped inequalities, defined as absolute mortality differences across poor and rich municipalities.

Main findings

Fortunately, we observe mortality reductions among all poverty groups, across all age-groups and for both men and women. Until the age of 64, reductions in mortality were largest in the poorer areas. For example, mortality of the poorest men aged 20 to 49 decreased by 2.5 times as much compared to the wealthiest men within our study period. In contrast, the declines in mortality for the old were larger for the rich. More specifically, for women aged 80 and older, the drop was 23 percent larger among the rich. Our results suggest that mortality inequalities have shifted from younger to older ages over time.

Related findings

To shed light on why trends may differ across groups, we distinguish between deaths that could have potentially been avoided by public health interventions (preventable deaths) or by timely and effective healthcare provision (treatable deaths). Large drops in preventable deaths seem to explain a large extent of the decline in disparities for the young.

Although inequalities in mortality continue to exist for the older Dutch population, these disparities are relatively small compared to the United States. A larger international comparison study (including our results) reports much larger inequalities in the United States when compared to in European countries. The authors report that this holds for both black and white Americans.

About the author

Marlies Bär is a PhD Candidate at the department of Health Economics at the Erasmus School of Health Policy & Management. Her main focus is on long-term care and income related inequalities in health. You can contact Marlies via email:

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