BACKGROUND: Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010. METHODS: Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities. RESULTS: We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities. CONCLUSIONS: Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.

Departamento de Geografia Centro de Estudos de Geografia e de Ordenamento do Territorio Colégio de S Jerónimo Universidade de Coimbra Coimbra Portugal

Department of Preventive Medicine and Public Health Universidad Complutense de Madrid Madrid Spain

Department of Public Health Erasmus University Medical Centre Rotterdam The Netherlands

Department of Public Health Sciences Division of Social Medicine Karolinska Institutet Stockholm Sweden

Department of Public Health University of Helsinki Helsinki Finland

Department of Social Geography and Regional Development Faculty of Science Charles University Prague Prague Czech Republic

Faculty of Public Health Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Institute of Social and Preventive Medicine University of Zurich Zurich Switzerland

National Institute of Public Health University of Southern Denmark Copenhagen Denmark

Stockholm Centre on Health of Societies in Transition Södertörn University Huddinge Sweden Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn Estonia

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