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In Norway, a country with a largely tax-financed universal health care system and moderate income differences, does life expectancy vary with income, and are differences comparable to differences in the United States?
In this registry-based study that included data from 3 041 828 persons aged at least 40 years in Norway between 2005 and 2015, the difference in life expectancy between the richest and poorest 1% was 8.4 years for women and 13.8 years for men. The differences widened between 2005 and 2015 and were comparable to those in the United States.
Inequalities in life expectancy by income in Norway were substantial and increased between 2005 and 2015.
Examining causes of death and making comparisons across countries may increase understanding of the income-related differences in life expectancy.
To describe income-related differences in life expectancy and causes of death in Norway and to compare those differences with US estimates.
Design and Setting
A registry-based study including all Norwegian residents aged at least 40 years from 2005 to 2015.
Household income adjusted for household size.
Main Outcomes and Measures
Life expectancy at 40 years of age and cause-specific mortality.
In total, 3 041 828 persons contributed 25 805 277 person-years and 441 768 deaths during the study period (mean [SD] age, 59.3 years [13.6]; mean [SD] number of household members per person, 2.5 [1.3]). Life expectancy was highest for women with income in the top 1% (86.4 years [95% CI, 85.7-87.1]) which was 8.4 years (95% CI, 7.2-9.6) longer than women with income in the lowest 1%. Men with the lowest 1% income had the lowest life expectancy (70.6 years [95% CI, 69.6-71.6]), which was 13.8 years (95% CI, 12.3-15.2) less than men with the top 1% income. From 2005 to 2015, the differences in life expectancy by income increased, largely attributable to deaths from cardiovascular disease, cancers, chronic obstructive pulmonary disease, and dementia in older age groups and substance use deaths and suicides in younger age groups. Over the same period, life expectancy for women in the highest income quartile increased 3.2 years (95% CI, 2.7-3.7), while life expectancy for women in the lowest income quartile decreased 0.4 years (95% CI, −1.0 to 0.2). For men, life expectancy increased 3.1 years (95% CI, 2.5-3.7) in the highest income quartile and 0.9 years (95% CI, 0.2-1.6) in the lowest income quartile. Differences in life expectancy by income levels in Norway were similar to differences observed in the United States, except that life expectancy was higher in Norway in the lower to middle part of the income distribution in both men and women.
Conclusions and Relevance
In Norway, there were substantial and increasing gaps in life expectancy by income level from 2005 to 2015. The largest differences in life expectancy between Norway and United States were for individuals in the lower to middle part of the income distribution.
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Accepted for Publication: April 10, 2019.
Corresponding Author: Jonas Minet Kinge, PhD, Norwegian Institute of Public Health, Postboks 222-Skøyen, 0213 Oslo, Norway (Jonas.Minet.Kinge@fhi.no).
Published Online: May 13, 2019. doi:10.1001/jama.2019.4329
Author Contributions: Dr Kinge had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kinge, Modalsli, Øverland, Vollset.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Kinge, Modalsli, Øverland, Skirbekk, Håberg.
Critical revision of the manuscript for important intellectual content: Kinge, Modalsli, Øverland, Gjessing, Tollånes, Knudsen, Strand, Håberg, Vollset.
Statistical analysis: Kinge, Modalsli, Gjessing, Håberg, Vollset.
Obtained funding: Øverland, Vollset.
Administrative, technical, or material support: Kinge, Øverland, Vollset.
Supervision: Kinge, Strand, Vollset.
Conflict of Interest Disclosures: Dr Kinge reported receiving grants from the Research Council of Norway during the conduct of the study. Dr Gjessing reported receiving grants from the Research Council of Norway during the conduct of the study and outside the submitted work. Dr Håberg reported receiving grants from the Research Council of Norway during the conduct of the study. No other disclosures were reported.
Funding/Support: This work was funded by the Research Council of Norway through FRIPRO (project number 262030), its Centres of Excellence funding scheme (project number 262700), and by the Norwegian Institute of Public Health.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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