Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.

Agència de Salut Pública de Barcelona 08023 Barcelona Spain

Demographic Research Institute 1525 Budapest Hungary

Department of Demography Charles University 128 43 Prague 2 Czech Republic

Department of Epidemiology and Biostatistics National Institute for Health Development 11619 Tallinn Estonia

Department of Monitoring and Analyses of Population Health National Institute of Public Health National Institute of Hygiene 00 791 Warsaw Poland

Department of Preventive Medicine and Public Health Universidad Complutense de Madrid 28040 Madrid Spain

Department of Public Health Erasmus University Medical Center 3015 CE Rotterdam The Netherlands

Department of Public Health Erasmus University Medical Center 3015 CE Rotterdam The Netherlands;

Department of Public Health Faculty of Medicine 1000 Ljubljana Slovenia

Department of Sociology University of Helsinki 00100 Helsinki Finland

Department of Sociology Vrije Universiteit Brussel 1050 Ixelles Belgium

Epidemiology Biostatistics and Prevention Institute University of Zürich 8006 Zurich Switzerland

INSERM Sorbonne Universités Institut Pierre Louis d'Epidémiologie et de Santé Publique 75646 Paris France

Institute of Public Health Copenhagen University 1165 Copenhagen Denmark

Lithuanian University of Health Sciences Kaunas 44307 Lithuania

Medical Research Council Public Health England Centre for Environment and Health School of Public Health Imperial College London W2 1PG United Kingdom

Office of National Statistics Newport NP10 8XG United Kingdom

Stockholm Centre for Health and Social Change Södertörn University 89 Huddinge Sweden

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