The Potential Impact of a Social Redistribution of Specific Risk Factors on Socioeconomic Inequalities in Mortality

Rasmus Hoffmann, Erasmus Medical Centre, Rotterdam
Terje A. Eikemo, Erasmus Medical Centre, Rotterdam
Ivana Kulhánová, Erasmus Medical Centre, Rotterdam
Margarete C. Kulik, Erasmus Medical Centre, Rotterdam
Marlen Toch, Norwegian University of Science and Technology
Gwenn Menvielle, Institut National de la Santé et de la Recherche Médicale (INSERM)
Johan P. Mackenbach, Erasmus Medical Centre, Rotterdam
EURO-GBD-SE Consortium

Evidence on the contribution of risk factors to health inequality is scarce. We quantify the impact of modifying risk factor distributions on educational mortality differences using the Population Attributable Fraction. This is done for scenarios in which the social distribution of risk factors changes in 20 European populations. We also estimate the effect of a change in the educational distribution on the overall level of mortality. We use national data on risk factor prevalence and mortality, and rate ratios from epidemiologic reviews on the impact of risk factors on mortality. The scenarios where the whole population has the same prevalence of physical activity, smoking and BMI as the high educated show that excess mortality of low educated persons would drop by 2 to 49 percent. A redistribution of income results in smaller reductions of inequalities. We present a promising tool for quantifying the effect of policy interventions on health inequality.