Abstract
OBJECTIVES: For several decades, mortality has decreased more rapidly among individuals with a higher socioeconomic position than among those with a lower position. This widening social inequality gap has increasingly been recognised as an important aspect of public health research and policies. The objective of this study was to examine trends in educational inequality in healthy life expectancy (HLE) in Denmark between 2010 and 2021 at the age of 30 years. DESIGN: The study is a population-based study based on register data on longest attained education, standard life tables and self-reported health information from nationwide health surveys. SETTING: The study is conducted among the general adult population in Denmark. PARTICIPANTS: Participants include respondents from the Danish National Health Survey and the Danish Health and Morbidity Survey in 2010, 2013, 2017 and 2021 aged ≥30 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Expected lifetime in good self-rated health, with no long-standing illness and with no activity limitations was estimated by Sullivan's method, and educational inequality was expressed by the Slope Index of Inequality. RESULTS: Between 2010 and 2021, educational inequality in HLE increased among both men and women for long-standing illness (5-year trend: +1.1 and +1.2 years) and activity limitations (+2.4 and +2.6 years) but remained stable among men (+0.1 year) and decreased among women (-0.3 year) for self-rated health. For the latter two indicators, the inequality gap narrowed after 2017. CONCLUSION: Trends in educational inequality in HLE in Denmark 2010-2021 vary by health indicator. Steadily widening gaps were demonstrated for long-standing illness, while narrowing gaps were seen after 2017 for activity limitations and self-rated health. Future studies are encouraged to explore potential health risk behaviours that may explain or modify these inequality trends.