Unequal healthy ageing trajectories across Europe: socioeconomic development and age-related disease burden in the European Union and South-Eastern European countries

Abstract

Although life expectancy has increased, many of the added years are lived in poor health, highlighting growing inequalities in ageing trajectories. Despite the increasing need for ageing-related health strategies, non-EU European countries remain underrepresented in comparative research, leaving limited evidence on healthy ageing disparities between EU and South-Eastern European (SEE) nations. This study explored variations in key health and socioeconomic indicators of societal ageing and age-related disease burden among individuals aged 70 and older across European countries, with a focus on EU and non-EU SEE nations. Data for 33 European countries were extracted from Global Burden of Disease 2021 study. Indicators included mortality, years lived with disability (YLD), healthy life expectancy (HALE), current health expenditure (HE), and Human Development Index (HDI). Hierarchical cluster analysis was used to classify EU countries, and SEE countries were analysed separately. Trends in mortality, YLD rates, and HALE were analysed using Joinpoint regression. Spearman’s rank correlation was used to assess relationships between health, socioeconomic factors, and disease burden. Western and Northern European countries showed the most favourable values for indicators, while SEE countries exhibited the highest all-cause and cardiovascular mortality and the lowest HALE and HDI values. Across all countries, strong negative correlations were observed between HE, HDI, HALE, and total mortality (r = -0.81, -0.82, and -0.92, p < 0.001; respectively). Regionally adjusted and coordinated policies are needed to reduce inequalities and promote healthy ageing across Europe. Such strategic integration is essential to narrowing the gaps in ageing trajectories and socioeconomic development between EU and SEE countries.

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