摘要：Objectives. We examined the contribution that specific diseases, as causes of both death and disability, make to educational disparities in disability-free life expectancy (DFLE). Methods. We used disability data from the Belgian Health Interview Survey (1997) and mortality data from the National Mortality Follow-Up Study (1991–1996) to assess education-related disparities in DFLE and to partition these differences into additive contributions of specific diseases. Results. The DFLE advantage of higher-educated compared with lower-educated persons was 8.0 years for men and 5.9 years for women. Arthritis (men, 1.3 years; women, 2.2 years), back complaints (men, 2.1 years), heart disease/stroke (men, 1.5 years; women, 1.6 years), asthma/chronic obstructive pulmonary disease (COPD) (men, 1.2 years; women, 1.5 years), and “other diseases” (men, 2.4 years) contributed the most to this difference. Conclusions. Disabling diseases, such as arthritis, back complaints, and asthma/COPD, contribute substantially to differences in DFLE by education. Public health policy aiming to reduce existing disparities in the DFLE and to improve population health should not only focus on fatal diseases but also on these nonfatal diseases. Socioeconomic differences in health have been reported to be substantial and persistent. Mortality and morbidity, including the prevalence of reported chronic conditions and disability, is higher in the lower socioeconomic groups than among persons with a higher socioeconomic status. 1 , 2 Together, these disadvantages in mortality and morbidity have been shown to create large differences in population health. For a variety of definitions of health, for different indicators of socioeconomic status, and on the basis of both cross-sectional and longitudinal data, studies on socioeconomic differences in health expectancy have consistently shown that persons in the lower socioeconomic groups spend fewer years free of disability or in good health. Moreover, despite their shorter total life expectancy, these persons live longer with disability or ill health than persons in higher socioeconomic groups. 3 – 16 Elimination of inequalities in population health is a primary goal of health politics. 1 , 17 Greatest success is likely to be achieved by targeting diseases that have the greatest impact on inequalities in health. Some prior studies have examined the contribution of specific diseases to socioeconomic health differences. Mortality rates among persons with lower socioeconomic status were shown to be higher for almost all causes of death, 1 , 18 , 19 but the contribution of specific causes to differences in total mortality has been found to vary between countries. 19 , 20 Only 3 studies 21 – 23 assessed the contribution of specific causes to disparities in life expectancy, showing largest contributions for ischemic heart diseases, other cardiovascular diseases, cancers, and respiratory diseases. A major limitation of these studies, however, is that they included only the fatal consequences of diseases. Socioeconomic differences in nonfatal health outcomes have been taken into account in studies on health expectancy. Although socioeconomic differences in health expectancy have shown to be even more pronounced than in life expectancy, 3 – 16 none of these studies has examined the contribution of specific diseases to these differences. We extended prior studies on the contribution of specific diseases to socioeconomic health differences in disability-free life expectancy (DFLE). On the basis of Belgian data, we used a new method 24 to examine the contribution of specific diseases to inequalities in health expectancy measures. Our study assessed the contribution that 7 disease groups make to educational differences in DFLE.
