© 2004 by European Journal of Public Health
Inequalities |
Investigating explanations of socio-economic inequalities in health
The Dutch GLOBE study
Frank J. van Lenthe1,*, Carola T.M. Schrijvers1, Mariel Droomers1, Inez M.A. Joung1, Marieke J. Louwman1 and Johan P. Mackenbach11 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
Background: The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described. Methods: The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15–74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death. Results: Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation. Conclusions: The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands.
Keywords: longitudinal studies, socio-economic inequalities in health, the Netherlands
Received 30 August 2002. Accepted 26 November 2002.
* Correspondence: Frank J. van Lenthe, PhD, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands, tel. +31 10 408 8220, fax +31 10 408 9449, e-mail: f.vanlenthe{at}erasmusmc.nl
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