Mind the gap: analysis of sub-national differences in life expectancy at birth in the European Union

BACKGROUND: Life Expectancy (LE) at birth, the average number of years a person is expected to live from birth, with constant age-specific mortality, is an essential indicator of a country or region's well-being, highlighting progress and gaps in societal health, including at the sub-national level. In this study, our goal was to analyse sub-national gaps in LE at birth in European Union (EU) member states, between 2000 and 2020. METHODS: A retrospective longitudinal analysis on differences in LE at birth among NUTS2 regions within EU countries was performed, in 2000-2020, taking the largest absolute difference between NUTS2 regions as the country value. Estimates were analysed for the EU mean and 20 member states, due to data availability. All data was retrieved from Eurostat and analysis performed in R version 4.0.0. RESULTS: The mean gap in LE in the EU increased from 2.46 to 2.73 between 2000 and 2020, reaching its maximum in 2010 (2.82) and its minimum in 2012 (2.43), with great variability across countries. In 2000, the top 3 countries with the largest gap in LE were Greece (4.40), Portugal (4.10) and France (3.60), while in 2020 the top 3 was composed of Belgium, Spain (both 4.60) and Hungary (4.10). The bottom 3 countries with the lowest gaps in LE were Lithuania (0.20), Sweden (1.10) and Hungary (1.40) in 2000, and Lithuania (1.00), Sweden (1.30) and the Netherlands (1.50) in 2020. Lithuania was the country with the lowest value in 2007 (0.00), and Spain the highest (5.50) in 2010. CONCLUSIONS: The mean gap in LE at birth in the EU increased in 2000-2020, with great variability across countries. Further research should address possible associations with policy options at the regional level, such as health expenditure and employment support schemes, in order to reduce inequalities. KEY MESSAGES: • Important sub-national gaps in LE at birth persist in the EU, with considerable variability across countries. • These results may have considerable implications for policy-making and priority-setting.