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Background: Several studies have revealed widening of inequalities in life expectancy, but little is known about the recent changes in health expectancy nationally and between socioeconomic groups. This study examines dynamics of national and education-specific life expectancy and health expectancies at age 50 years in Denmark from 2004/2007 to 2015. Methods: Nationwide register data on education and mortality were linked and combined with Danish health data from the Survey of Health, Ageing and Retirement in Europe and changes in life expectancy and three health expectancy indicators were estimated by Sullivan's method. Results: From 2004 to 2015, national life expectancy at age 50 years increased by 2.4 years for men and 2.1 years for women. Simultaneously, after an initial rapid improvement from 2004 to 2007, the pace of progress in health expectancy decreased. From 2007 to 2015, the difference in life expectancy at age 50 years between men with long and short education increased from 4.3 to 5.0 years. For women, the corresponding increase in the life expectancy gap was less pronounced from 3.5 to 3.8 years. The educational gap in lifetime without long-term illness decreased from 4.6 years to 3.1 years for men and from 6.1 years to 4.6 years for women. On the contrary, the educational gap increased for lifetime without activity limitations and in self-rated good health. Conclusions: Previously observed improvements in health expectancy in Denmark slowed down despite continuing progress in life expectancy. This worrying change coincides with persistent educational inequalities in life expectancy and health expectancy and is a challenge to a sustainable social and health development in the future. [ABSTRACT FROM AUTHOR]

Objectives: Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. Methods: We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. Results: When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose–response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. Discussion: Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia. [ABSTRACT FROM AUTHOR]

Abstract Background Competence in video-assisted thoracoscopic surgery lobectomy has previously been established on the basis of numbers of procedures performed, but this approach does not ensure competence. Specific assessment tools, such as the newly developed video-assisted thoracoscopic surgery lobectomy assessment tool, allow for structured and objective assessment of competence. Our aim was to provide validity evidence for the video-assisted thoracoscopic surgery lobectomy assessment tool. Methods Video recordings of 60 video-assisted thoracoscopic surgery lobectomies performed by 18 thoracic surgeons were rated using the video-assisted thoracoscopic surgery lobectomy assessment tool. All 4 centers of thoracic surgery in Denmark participated in the study. Two video-assisted thoracoscopic surgery experts rated the videos. They were blinded to surgeon and center. Results The total internal consistency reliability Cronbach's alpha was 0.93. Inter-rater reliability between the 2 raters was Pearson's r = 0.71 (P <.001). The mean video-assisted thoracoscopic surgery lobectomy assessment tool scores for the 10 procedures performed by beginners were 22.1 (standard deviation [SD], 8.6) for the 28 procedures performed by the intermediate surgeons, 31.2 (SD, 4.4), and for the 20 procedures performed by experts 35.9 (SD, 2.9) (P <.001). Bonferroni post hoc tests showed that experts were significantly better than intermediates (P <.008) and beginners (P <.001). Intermediates' mean scores were significantly better than beginners (P <.001). The pass/fail standard calculated using the contrasting group's method was 31 points. One of the beginners passed, and 2 experts failed the test. Conclusions Validity evidence was provided for a newly developed assessment tool for video-assisted thoracoscopic surgery lobectomy (video-assisted thoracoscopic surgery lobectomy assessment tool) in a clinical setting. The discriminatory ability among expert surgeons, intermediate surgeons, and beginners proved highly significant. The video-assisted thoracoscopic surgery lobectomy assessment tool could be an important aid in the future training and certification of thoracic surgeons. [ABSTRACT FROM AUTHOR]

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 selfreported morbidity from ca. 2002 to ca. 2014 for 27 countries covering 350,000 survey respondents. We used interrupted timeseries 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 selfassessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisisrelated 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. [ABSTRACT FROM AUTHOR]

Aims: The state old-age pension in Denmark increases to keep pace with the projected increase in average life expectancy (LE) without any regard to the social gap in LE and expected lifetime in good health. The purpose of this study was to compare changes in LE and disability-free life expectancy (DFLE) between groups of Danes with high, medium and low levels of education. Methods: Nationwide register data on education and mortality were combined with data from the Surveys of Health, Ageing and Retirement in Europe (SHARE) surveys in 2006–2007, 2010–2011 and 2013–2014 and the DFLE by educational level was estimated by Sullivan’s method for each of these three time points. Results: Between 2006–2007 and 2013–2014, LE among 65-year-old men and women with a low educational level increased by 1.3 and 1.0 years, respectively, and by 1.4 and 1.3 years for highly educated men and women. The gap in LE between people with high and low levels of education remained more than 2 years. In 2006–2007, 65-year-old men with a high level of education could expect 3.2 more years without disability than men of the same age with a low level of education. In 2013–2014, the difference was 2.9 years. For women, the results were 3.7 and 3.4 years, respectively. Conclusions: With the persistent social inequality in LE of more than 2 years and the continuous gap between high and low educational groups in DFLE of about 3 years, a differential pension age is recommended. [ABSTRACT FROM AUTHOR]