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      Changing educational gradient in long-term care-free life expectancy among German men, 1997-2012

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      PLoS ONE
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          Abstract

          Background

          The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs.

          Objectives

          We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time.

          Data and methods

          We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997–2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan’s method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE.

          Results

          There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level.

          Conclusions

          Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups.

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          Most cited references54

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          Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010

          The Lancet, 380(9859), 2144-2162
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            Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe.

            In this paper we review the available summary measures for the magnitude of socio-economic inequalities in health. Measures which have been used differ in a number of important respects, including (1) the measurement of "relative" or "absolute" differences; (2) the measurement of an "effect" of lower socio-economic status, or of the "total impact" of socio-economic inequalities in health upon the health status of the population; (3) simple versus sophisticated measurement techniques. Based on this analysis of summary measures which have previously been applied, eight different classes of summary measures can be distinguished. Because measures of "total impact" can be further subdivided on the basis of their underlying assumptions, we finally arrive at 12 types of summary measure. Each of these has its merits, and choice of a particular type of summary measure will depend partly on technical considerations, partly on one's perspective on socio-economic inequalities in health. In practice, it will often be useful to compare the results of several summary measures. These principles are illustrated with two examples: one on trends in the magnitude of inequalities in mortality by occupational class in Finland, and one on trends in the magnitude of inequalities in self-reported morbidity by level of education in the Netherlands.
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              Widening socioeconomic inequalities in mortality in six Western European countries

              During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 September 2019
                2019
                : 14
                : 9
                : e0222842
                Affiliations
                [1 ] Max Planck Institute for Demographic Research, Rostock, Germany
                [2 ] Institute for Sociology and Demography, University of Rostock, Rostock, Germany, German Center for Neurodegenerative Disease, Bonn, Germany
                Catholic University of Korea College of Medicine, REPUBLIC OF KOREA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-5356-0835
                http://orcid.org/0000-0001-7746-0652
                Article
                PONE-D-18-32830
                10.1371/journal.pone.0222842
                6752958
                31537015
                39e68110-149c-4e9b-b623-09ec41fc1857
                © 2019 Grigoriev, Doblhammer

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 November 2018
                : 8 September 2019
                Page count
                Figures: 2, Tables: 4, Pages: 20
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Life Expectancy
                Medicine and Health Sciences
                Public and Occupational Health
                Life Expectancy
                Social Sciences
                Sociology
                Education
                Educational Attainment
                Medicine and Health Sciences
                Health Care
                Long-Term Care
                People and Places
                Population Groupings
                Ethnicities
                European People
                German People
                Social Sciences
                Economics
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Custom metadata
                The authors confirm that some access restrictions apply to the data underlying the findings presented here and therefore these data cannot be shared publicly. These data are available upon requests and on different conditions: 1. Data from the German Socio-Economic Panel (GSOEP) are made available for scientific research by the German Institute for Economic Research (DIW). The use of anonymized GSOEP data is subject to strict standards in the data provision. These data are reserved exclusively for research use. GSOEP data are available free of charge as the scientific use files, yet signing a contract on data distribution with the DIW Berlin is required for working with data (mail: soepmail@ 123456diw.de ). 2. The anonymized Microcensus data can be purchased from the Research Data Centre of the Federal Statistical Office. The use of micro data is bound to a specific purpose. It is temporary and liable for costs. Signing a contract on data distribution is required for working with MC data. More information on the access to data is available at: https://www.forschungsdatenzentrum.de/en/access. 3. In order to obtain the anonymized administrative health claims data from the AOK, all interested researchers should send a request to the Scientific Research Institute of the AOK (WldO, http://www.wido.de/). Since the health claims data are sensible data, there are strict rules at the WIdO regarding data sharing. After obtaining a permission and/or signing an agreement for using data from the above mentioned data providers, all interested researchers will be able to obtain them in the same manner as the authors did. We confirm that the authors did not have any special access privileges.

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