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All rights reserved. doi:10.1093/eurpub/ckaa155 Advance Access published on 6 October 2020 ......................................................................................................... Healthcare system performance and socioeconomic inequalities in hearing and visual impairments in 17 European countries Asri Maharani 1 , Piers Dawes 2,3 , James Nazroo 4 , Gindo Tampubolon 4 , Neil Pendleton 5 on behalf of the SENSE-Cog WP1 group* 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK 2 Division of Human Communication, Development & Hearing, University of Manchester, Manchester, UK 3 Department of Linguistics, The Australian Hearing Hub, Macquarie University, Sydney, NSW, Australia 4 Division of Social Statistics, Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK 5 Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK *The members of the SENSE-Cog WP1 Group are listed in the Acknowledgement. Correspondence: Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room 6.329 Jane McFarlane Building, Oxford Road, Manchester M13 9PL, UK, Tel: þ44 (0) 16 13 068705, e-mail address: asri.maharani@manchester.ac.uk Background: Socioeconomic status is associated with health status among older adults, including hearing and vision impairments, and healthcare system performance is an important consideration in examining that associ- ation. We explored the link between a country’s healthcare system performance and the hearing and visual impairments of its people in Europe. Methods: This study enrolled 65 332 individuals aged 50þ from 17 countries participating in the Survey of Health, Ageing and Retirement in Europe Wave 6. We used latent class analysis to identify groups of countries based on six domains of healthcare system performance. We then performed multiple logistic regressions to quantify the association between socioeconomic status and hearing and visual impairments adjusted for demographic and other co-variates; finally, we compared the patterns of observed associations in each of the country groups. Results: The latent class analysis separated countries into three groups based on the performance of their healthcare systems: poor, moderate and high. Respondents in countries with moderate and poor healthcare performance were more likely to experience hearing and visual impairment than those in coun- tries with high healthcare performance. With respect to hearing and visual impairments, wealth gradients at the individual level varied among countries in different healthcare performance groups, with less wealth associated with worse hearing and seeing only in the countries with moderate and poor healthcare performance. Conclusion: The relationships between wealth and hearing and visual impairments differ among countries with different healthcare performance. ......................................................................................................... Healthcare system performance and socioeconomic inequalities 79 Downloaded from https://academic.oup.com/eurpub/article/31/1/79/5918137 by guest on 19 June 2022