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Wilma J. Nusselder, PhD, Caspar W.N. Looman, MSc, Johan P. Mackenbach, MD, PhD, Martijn Huisman, PhD, Herman van Oyen, MD, DrPH, MPH, DTM&H, Patrick Deboosere, MA, Sylvie Gadeyne, MA and Anton E. Kunst, PhD

Wilma J. Nusselder, Anton E. Kunst, Johan P. Mackenbach, Martijn Huisman, and Caspar W.N. Looman are with the Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Sylvie Gadeyne and Patrick Deboosere are with the Interface Demography, Centrum voor Sociologie, VUB, Brussels, Belgium. Herman van Oyen is with the Unit of Epidemiology, Scientific Institute for Public Health, Brussels.

Correspondence: Requests for reprints should be sent to Dr. Wilma J. Nusselder, Erasmus MC, Department of Public Health, PO Box 1738, 3000 DR Rotterdam, The Netherlands (e-mail: w.nusselder{at}erasmusmc.nl).

Objectives. We examined the contribution that specific diseases, as causes of both death and disability, make to educational disparities in disability-free life expectancy (DFLE).

Methods. We used disability data from the Belgian Health Interview Survey (1997) and mortality data from the National Mortality Follow-Up Study (1991–1996) to assess education-related disparities in DFLE and to partition these differences into additive contributions of specific diseases.

Results. The DFLE advantage of higher-educated compared with lower-educated persons was 8.0 years for men and 5.9 years for women. Arthritis (men, 1.3 years; women, 2.2 years), back complaints (men, 2.1 years), heart disease/stroke (men, 1.5 years; women, 1.6 years), asthma/chronic obstructive pulmonary disease (COPD) (men, 1.2 years; women, 1.5 years), and "other diseases" (men, 2.4 years) contributed the most to this difference.

Conclusions. Disabling diseases, such as arthritis, back complaints, and asthma/COPD, contribute substantially to differences in DFLE by education. Public health policy aiming to reduce existing disparities in the DFLE and to improve population health should not only focus on fatal diseases but also on these nonfatal diseases.

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