Life expectancy inequalities in Hungary over 25 years: The role of avoidable deaths

Health Inequity in the Distribution of Diseases Among Adults in the City of Pécs, Hungary, 2024

Background: Health inequalities between citizens of different European countries and between socially advantaged and disadvantaged groups are seen as challenges to the EU's commitment to solidarity, social and economic cohesion, human rights, and equality of opportunity. This study aimed to assess inequity in the distribution of specific communicable and non-communicable diseases among the adult population of Pécs City, Hungary. Methods: This is an ecological study combined with health inequity analysis. The study population comprised adult patients living in the city of Pécs who were treated for circulatory, neoplasm, or respiratory diseases in 2019. Hospitalization and local socioeconomic data by zip codes were obtained from the National Health Insurance Fund of Hungary and the Hungarian Central Statistical Office. Diseases were classified according to the International Classification of Diseases, 10th revision (ICD-10). The differences and ratios of the proportions of treated diseases were calculated, along with the concentration index (C). Zip codes were ranked into categories 1 to 5 based on socio-demographic variables: education, employment status, and apartment ownership. A p-value of less than 0.05 was used as the cut-off point for statistical significance. IBM SPSS version 25 and STATA version 14.0 software were used for data analysis. Results: All 36 zip codes in the city of Pécs were included in this study. Analysis based on employment status showed a higher prevalence of neoplasms in areas with higher unemployment (C = -0.0528; 95% CI = -0.0975, -0.0080). In terms of apartment ownership, neoplasms (C = -0.0742; 95% CI = -0.1102, -0.0382) and circulatory diseases (C = -0.0280; 95% CI = -0.0520, -0.0039) were more prevalent in zip codes with fewer apartment owners. Conclusions: This study identified significant inequity in the distribution of neoplasms and circulatory diseases among the adult population of Pécs, especially in areas where the low socioeconomic segment of the population lives. Efforts should be made to establish tailored interventions such as targeted healthcare funding and employment programs for the unemployed and National Housing Trust Fund for those who do not own houses through multisectoral collaboration among healthcare providers, employers, governors, and policymakers.

Poor housing quality and the health of newborns and young children

This study uses linked administrative data on live births, hospital stays, and census records for children born in Hungary between 2006 and 2011 to examine the relationship between poor housing quality and the health of newborns and children aged 1-2 years. We show that poor housing quality, defined as lack of access to basic sanitation and exposure to polluting heating, is not a negligible problem even in a high-income EU country like Hungary. This is particularly the case for disadvantaged children, 20-25% of whom live in extremely poor-quality homes. Next, we provide evidence that poor housing quality is strongly associated with lower health at birth and a higher number of days spent in inpatient care at the age of 1-2 years. These results indicate that lack of access to basic sanitation, hygiene, and non-polluting heating and their health impacts cannot be considered as the exclusive problem for low- and middle-income countries. In high-income countries, there is also a need for public policy programs that identify those affected by poor housing quality and offer them potential solutions to reduce the adverse effects on their health.

Socio-economic inequalities in smoking and drinking in adolescence: Assessment of social network dynamics

AIMS

We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.

DESIGN

This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves.

SETTING

Eight Hungarian secondary schools with socio-economically diverse classes took part.

PARTICIPANTS

This study comprised 232 adolescents aged between 14 and 15 years in the first wave.

MEASUREMENTS

Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit.

FINDINGS

Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES.

CONCLUSIONS

Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.

The gap in life expectancy and lifespan inequality between Iran and neighbour countries: the contributions of avoidable causes of death

Background

Healthcare system and intersectoral public health policies play a crucial role in improving population health and reducing health inequalities. This study aimed to quantify their impact, operationalized as avoidable deaths, on the gap in life expectancy (LE) and lifespan inequality (LI) between Iran and three neighbour countries viz., Turkey, Qatar, and Kuwait in 2015–2016.

Methods

Annual data on population and causes of deaths by age and sex for Iran and three neighbour countries were obtained from the World Health Organization mortality database for the period 2015–2016. A recently developed list by the OECD/Eurostat was used to identify avoidable causes of death (with an upper age limit of 75). The cross-country gaps in LE and LI (measured by standard deviation) were decomposed by age and cause of death using a continuous-change model.

Results

Iranian males and females had the second lowest and lowest LE, respectively, compared with their counterparts in the neighbour countries. On the other hand, the highest LIs in both sexes (by 2.3 to 4.5 years in males and 1.1 to 3.3 years in females) were observed in Iran. Avoidable causes contributed substantially to the LE and LI gap in both sexes with injuries and maternal/infant mortality represented the greatest contributions to the disadvantages in Iranian males and females, respectively.

Conclusions

Higher mortality rates in young Iranians led to a double burden of inequality –shorter LE and greater uncertainty at timing of death. Strengthening intersectoral public health policies and healthcare quality targeted at averting premature deaths, especially from injuries among younger people, can mitigate this double burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01683-8.

Income gradient of pharmaceutical panic buying at the outbreak of the COVID-19 pandemic

We analyze the timing, magnitude, and income dependence of pharmaceutical panic buying around the outbreak of the COVID-19 pandemic in Hungary. We use district-level monthly and daily administrative data on detailed categories of pharmaceutical purchases, merge them to income statistics, and estimate multilevel panel models. Our main results are as follows. First, the days of therapy (DOT) of pharmaceutical purchases increased by more than 30% in March 2020, when major lockdown measures were announced. This pattern holds for almost all categories of pharmaceuticals. Second, shortly after the panic reactions, the aggregate amount of pharmaceutical purchases returned to their preshock levels; however, the frequency of pharmacy visits decreased. Third, the panic buying reaction was significantly stronger in richer geographical areas, where-according to the daily data-people also reacted earlier to the pandemic-related news. Overall, the results suggest that panic buying of pharmaceuticals can have detrimental effects on vulnerable populations.