Mortality inequalities in crises and living arrangements in Europe

Serena Vigezzi*

*Corresponding author for this work

Research output: ThesisPh.D. thesis

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Abstract

Living arrangements have long been proven to be strongly tied with age at death, with single individuals typically dying earlier than their married counterparts. In recent decades, this mortality gap has deepened in low-mortality countries, including in Europe. This trend is compounded by a growing proportion of people living on their own, creating an alarming situation, as more and more individuals can be expected to experience an intensifying disadvantage. At the same time, public policy largely overlooks inequalities based on living arrangements, with the risk of leaving the door open for the constitution of a large and vulnerable group, that will lack informal systems of care and support.

The main aim of this thesis is to highlight the societal consequences of mortality inequalities by living arrangement in Danish society. It does so by focusing on two circumstances that place increasing stress on the health and welfare systems, which are supposed to address these inequalities. On the one hand, population ageing endangers the financial sustainability of retirement systems across Europe, but reforms to tackle this issue often fail to consider their impact in a context of increasing inequalities. On the other hand, the recent COVID-19 pandemic has intensified pre-existing inequalities in mortality by disproportionately affecting the most disadvantaged subpopulations. As public health emergencies are likely to become more frequent and intense, we must understand their impact on existing inequalities. While the interaction between socioeconomic inequalities and patterns of both retirement and COVID-19 mortality is clear, fewer studies have considered living arrangements. It remains therefore difficult to attest to the role played by household composition in these respects.

In this thesis I present three papers. The first two focus on inequalities by living arrangement, while the third investigates overall mortality inequalities in periods where detailed data on living arrangements are not available. The first paper quantifies inequalities in middle-age mortality by living arrangements in Denmark, in light of reforms to the retirement system. It highlights the widening of this gradient and shows how it interacts with policy to affect the retirement chances especially of single individuals. The second paper carries this line of investigation further to show the consequences of the pandemic on inequalities by living arrangement in Denmark. It reveals that the pandemic deepened only some of the pre-existing inequalities, for example sparing single individuals, but not nursing home residents. Moreover, it shows that these patterns were not driven by COVID-19 mortality. Finally, the third paper focuses on the impact of severe mortality crises on overall mortality inequality. The trends diverge depending on the measure used, suggesting that defining inequality is a crucial part of its study. This paper also uncovers the unexpected role of older ages in driving mortality differences, even in past centuries.

The question of mortality inequalities is pressing. They are wide and growing across Europe, challenging the efficacy of welfare and health systems and the social pact between citizens and states. By showing the strength of the relationship between mortality and living arrangements, as well as its relevance in two concrete instances, I highlight the necessity of studying mortality inequalities beyond socioeconomic characteristics and taking them into account in public policy. I also uncover the role of mortality crises in terms of survival inequalities, underscoring the need to protect the most vulnerable subgroups, while accounting for the possibility of unexpected patterns to arise.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Vaupel, James W., Principal supervisor
  • Baudisch, Annette, Principal supervisor
  • Permanyer, Iñaki, Co-supervisor, External person
  • Aburto, José Manuel, Co-supervisor
Date of defence27. Aug 2024
Publisher
DOIs
Publication statusPublished - 21. Aug 2024

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