Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender

Hadewijch Vandenheede, Patrick Deboosere, Albert Espelt, Matthias Bopp, Carme Borrell, Giuseppe Costa, Terje Andreas Eikemo, Roberto Gnavi, Rasmus Hoffmann, Ivana Kulhanova, Margarete Kulik, Mall Leinsalu, Pekka Martikainen, Gwenn Menvielle, Maica Rodriguez-Sanz, Jitka Rychtarikova, Johan P. Mackenbach

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© 2015, The Author(s). Objectives: To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders.Methods: Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and ‘gender × educational rank’.Results: An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0–3.9) in men versus 4.8 (95 % CI 3.2–7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated.Conclusions: Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.
Original languageEnglish
Pages (from-to)401-410
JournalInternational Journal of Public Health
Issue number4
Publication statusPublished - 1 May 2015


  • Diabetes mellitus
  • Education
  • Europe
  • Gender
  • Inequalities


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