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The Survey of Health, Ageing and
Re7rement in Europe: a tool for analysing health inequali7es in Europe ?
Florence Jusot
Université Paris-‐Dauphine Co-‐country leader of Share France
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1. Face-‐to-‐face survey of individuals aged 50 and over
2. Interna7onal -‐ In 18 European countries + Israël -‐ Closed to HRS (USA) et ELSA (UK) + China (CHARLS) + Japan (JSTAR) + India (LASI) + South America (SABE)
3. Longitudinal -‐ Panel -‐ Retrospec7f ques7onnaire on life history -‐SHARE LIFE-‐ in wave 3 and 7
2.
Survey characteris7cs
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Wave 1 : 2004/05 11 countries , 31 400 respondents Wave 2 : 2006/07 15 countries 34 400 respondents Wave 3 : 2008/09 15 pays 26 800 respondents Wave 4 : 2010/11 16 countries 58 500 respondents Wave 5 : 2012-‐2013 18 countries 65 000 respondents Wave 6: 2014-‐2015 18 countries + Israël 68 000 respondents Wave 7: 2016-2017:
28 countries
IE
PL
CZ
IL
EE
PT
SI
HU
UK
Corée Japon Chine
Inde
SE
DK
DE
CH AT FR
ES IT
GR
BE
NL
LU
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4. Mul7disciplinary survey -‐ Labor, re7rement, income, wealth, transferts -‐ Educa7on, family rela7onships, social networks -‐ Physical and mental health, cogni7ve limita7ons, mortality
5. For research -‐ Free access to data on www.share-‐project.org -‐ 2600 researchers, >800 ar7cles
Survey characteris7cs
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Owen O’Donnell (2009) , Measuring health inequali`es in Europe -‐ Methodological issues in the analysis of survey data Eurohealth Vol 15 No 3
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+ tests cogni7ve limita7ons + blood analysis + dental health + health care use and unmeet needs + long term care + health-‐related behaviors
Survey characteris7cs
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• Income • Educa7on • Occupa7on
• Wealth
• Country of birth and na7onality
• Social par7cipa7on, social network
• Social background: parents’ occupa7on, childhood condi7ons
Survey characteris7cs
Health inequali7es related to current socioeconomic status
Börsch-‐Supan A. et al (2005), First results book from Share Wave 1
Health inequali7es related to current socioeconomic status
Measurement of socioeconomic inequality in health in 10 European countries: An exploratory analysis of SHARE using three approaches (2006) by Cris`na Masseria, Elias Mossialos and Sara Allin
Health inequali7es related to current socioeconomic status
Measurement of socioeconomic inequality in health in 10 European countries: An exploratory analysis of SHARE using three approaches (2006) by Cris`na Masseria, Elias Mossialos and Sara Allin
Health inequali7es related to current socioeconomic status
Measurement of socioeconomic inequality in health in 10 European countries: An exploratory analysis of SHARE using three approaches (2006) by Cris`na Masseria, Elias Mossialos and Sara Allin
Health inequali7es related to current socioeconomic status
Measurement of socioeconomic inequality in health in 10 European countries: An exploratory analysis of SHARE using three approaches (2006) by Cris`na Masseria, Elias Mossialos and Sara Allin
Health inequali7es related to current socioeconomic status
Measurement of socioeconomic inequality in health in 10 European countries: An exploratory analysis of SHARE using three approaches (2006) by Cris`na Masseria, Elias Mossialos and Sara Allin
Health inequali7es related to immigra7on
Sole-‐Auro A., Crimmins E.M. (2008), Health of Immigrants in European countries Int Migr Rev., 42(4): 861–876.
Health inequali7es related to current socioeconomic status and social and family background
-0.0050 0.0000 0.0050 0.0100 0.0150 0.0200 0.0250 0.0300
Spain
Austria
Sweden
Switzerland
Belgium
Greece
Italy
France
Denmark
Germany
Netherlands
Contribution of wealth
Contribution of current professional occupation
Contribution of education level
Contribution of parental health
Contribution of social background
Tubeuf S., Jusot F. (2011), "Social health inequali`es among older Europeans: the contribu`on of social and family background", European Journal of Health Economics, 12, 1 : 61-‐77.
0.009 in Europe
Inequali7es of opportuni7es in health
Bricard D., Jusot F., Trannoy A., Tubeuf S. (2013), "Inequality of Opportuni`es in Health and the Principle of Natural Reward: Evidence from European Countries", In Pedro Rosa Dias, Owen O’Donnell (ed.) Health and Inequality (Research on Economic Inequality, Volume 21), Emerald Group Publishing Limited : 335-‐370.
IEF in health (Barry scenario)
0.009 in Europe
Inequali7es related to efforts
Bricard D., Jusot F., Trannoy A., Tubeuf S. (2013), "Inequality of Opportuni`es in Health and the Principle of Natural Reward: Evidence from European Countries", In Pedro Rosa Dias, Owen O’Donnell (ed.) Health and Inequality (Research on Economic Inequality, Volume 21), Emerald Group Publishing Limited : 335-‐370.
SOP in health (Barry scenario)
Low IEF Large IOP Low IOP Large IEF
49% in Europe
Share of inequali7es of opportunity in explained health inequali7es
Income related inequali7es in health care use in France
Or Z., Jusot F., Marcoux L., Yilmaz E. (2010) "Inégalités de consomma`ons de soins en Europe : Quel rôle anribuable aux systèmes de santé ?", rapport Irdes
BREASCR FLU EYE COL
Odds Ratio Odds Ratio Odds Ratio Odds RatioEducation level
No, primary or lower secondary ref ref ref ref ref ref ref refUpper / post secondary 1,35** 1,35** 1,09 1,03 1,56*** 1,53*** 1,35*** 1,28**
Tertiary 1,41* 1,42* 1,22 1,09 1,79*** 1,72*** 1,6*** 1,45***BMI
Underweight or normal ref - ref - ref - ref -Overweight 1,16*** - 1,12*** - 1,09** - 0,98 -
Obese 0,87** - 1,25*** - 1,02 - 0,93 -Self assessed health
Good or very good ref - ref - ref - ref -Less than good 0,96 - 1,54*** - 1,2*** - 1,68*** -
Inter-country variance 0,79*** 0,79*** 0,31*** 0,29*** 0,12*** 0,11*** 0,31*** 0,3***Variance education
Upper / post secondary 0,11*** 0,11*** 0,05*** 0,05*** 0,04*** 0,04*** 0,05** 0,04**Tertiary 0,22*** 0,22*** 0,12*** 0,11*** 0,1*** 0,1*** ns ns
BREASCR FLU EYE COL
Odds Ratio Odds Ratio Odds Ratio Odds RatioEducation level
No, primary or lower secondary ref ref ref ref ref ref ref refUpper / post secondary 1,35** 1,35** 1,09 1,03 1,56*** 1,53*** 1,35*** 1,28**
Tertiary 1,41* 1,42* 1,22 1,09 1,79*** 1,72*** 1,6*** 1,45***BMI
Underweight or normal ref - ref - ref - ref -Overweight 1,16*** - 1,12*** - 1,09** - 0,98 -
Obese 0,87** - 1,25*** - 1,02 - 0,93 -Self assessed health
Good or very good ref - ref - ref - ref -Less than good 0,96 - 1,54*** - 1,2*** - 1,68*** -
Inter-country variance 0,79*** 0,79*** 0,31*** 0,29*** 0,12*** 0,11*** 0,31*** 0,3***Variance education
Upper / post secondary 0,11*** 0,11*** 0,05*** 0,05*** 0,04*** 0,04*** 0,05** 0,04**Tertiary 0,22*** 0,22*** 0,12*** 0,11*** 0,1*** 0,1*** ns ns
*** significant at 0.01 level, ** significant at 0.05 level Controls for age and sex
Educa7onal inequali7es in preven7ve care use
Or Z., Jusot F., Marcoux L., Yilmaz E. (2010) "Inégalités de consomma`ons de soins en Europe : Quel rôle anribuable aux systèmes de santé ?", rapport Irdes
Significance level : *** 1% ; ** 5% ; * 10% All the equa`ons control for all other individual variables
Health system characteristics BREASCR FLU EYE COL O.R. O.R. O.R. O.R.
Pub Health Exp (% GDP) 1,02 1,09 1,21** 1,43***Out of pocket 0,96 0,97 1,00 0,98
Specialist density 0,46* 0,62** 1,15 0,88GP density 1,64 1,62* 1,37 1,69*
Gatekeeping 1,32 1,26 0,56*** 0,64National Health System 0,41 0,61* 0,89 0,62
Impact on mean probability of prevention use
Inequali7es in preven7ve care use and health systems characteris7cs
Significance level : *** 1% ; ** 5% ; * 10% All the equa`ons control for all other individual variables
Health system characteristics BREASCR FLU EYEO.R. O.R. O.R.
Pub Health Exp (% GDP) 0,93 1,07 0,96Out of pocket 1,02** 1,01 1,01
Specialist density 1,67*** 1,21* 1,23**GP density 1,18 1,17* 0,84
Gatekeeping 0,79 0,94 1,31*National Health System 0,72* 1,18 1,23*
Impact on educational inequalities
Inequali7es in preven7ve care use and health systems characteris7cs
Andrej Srakar, Valen`na Hlebec , Boris Majcen (2015), Determinants of unmet needs for long-‐term care of older people in the European Countries, Share First Results Book – Wave 5
Thank you for your acen7on
www.share-‐project.org
www.sharedauphine.fr
