Editorial introduction: Social and spatial inequalities in health and mortality: The analysis of longitudinal register data from selected European countries

Abstract

Health inequalities—systematic differences in health outcomes between social groups and across spatial units—are ubiquitous, but not necessarily inevitable. They are the product of a complex interplay of social and economic processes operating at various scales. The unequal pattern of infection and death seen in the Covid‐19 pandemic has served to highlight the stark social gradient in health that exists within many European countries. Although the complex social determinants of health have been studied for many decades, there is still a great deal of work to do to elucidate explanations for health inequalities across time and space. To rise to the challenge, we need high‐quality, representative data capable of capturing multi‐scalar longitudinal processes. This special issue brings together eight new studies which all use national population register data linked with various other sources of administrative data (e.g., residence, tax and health records) to investigate different vectors of inequalities in health and mortality, covering spatial, socioeconomic, ethnic and migrant status. This editorial outlines their contributions, argues for the invaluable role of population register data to understand health inequalities and suggests promising future research avenues.

Non-survival to pension age in Denmark and Sweden: a sub-national investigation

“…The focus on spatial disparities in survival to pension age is of clear relevance to local and national governments. The spatial differences at subnational level are stubbornly persistent (Keenan et al, 2022) and they represent a large part of the variance in survival and are generally a decent first level approximation to the socioeconomic gradients.…”

Do variations in anomalous mortality in Europe in fall and winter of 2019–2020 tell us anything on the timing of SARS‐CoV‐2 outbreak?

“…Overall, numerous studies indicate that there are many diversification patterns to COVID-19 deaths. The differences in the death rates in the COVID-19 pandemic have been explained by complex social determinants of health inequalities across time and space that exist within the European countries (Keenan et al, 2021). Different factors were found to have influenced the spatially uneven mortality rate of COVID-19 across regions including demographics, household and business size, air quality, as well as the share of older people in care homes, urbanization and economic dynamism, global circuit of capital and, finally, the policies implemented to mitigate the virus (Kapitsinis, 2020).…”

Spatial variation of migrant‐native mortality differentials by duration of residence in Belgium: A story of partial convergence

“…Several explanations have been suggested for the migrant mortality advantage, mainly focusing on five mechanisms: (i) selective immigration in terms of health status (healthy migrant effect), (ii) unregistered (r)emigration leading to an underestimation of death rates in migrant populations (data artefacts), (iii) selective emigration in terms of health status leading to an under‐registration of deaths (salmon bias), (iv) migration as a rapid health transition, and (v) foreign born retaining behaviours from their country of origin that positively influence their health (cultural effects) (Guillot et al, 2018; Keenan et al, 2021).…”

“…Substantive spatial variation in all‐cause and cause‐specific mortality has been documented in various contexts, which may represent regional variation in risk factors, regional variation in the composition of the resident population (e.g., in terms of socio‐economic position), and selective internal migration between regions in terms of health status (Keenan et al, 2021; Wilson et al, 2020). In Belgium, substantive spatial variation at both the regional and district level has been documented for all‐cause as well as cause‐specific mortality (Deboosere & Fiszman, 2009; Deboosere & Gadeyne, 2002; Duchene & Thiltgès, 1993; Eggerickx et al, 2018; Grimmeau et al, 2015).…”