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Background  Reducing socio-economic health inequalities is a public health priority, necessitating careful monitoring that should take into account changes in the population composition. We analyzed the evolution of educational inequalities in life expectancy and disability-free life expectancy at age 25 (LE 25  and DFLE 25 ) in Belgium between 2001 and 2011.    Methods  The 2001 and 2011 census data were linked with the national register data for a five-year mortality follow up. Disability prevalence estimates from the health interview surveys (2001 to 2013) were used to compute DFLE according to Sullivan’s method. LE 25  and DFLE 25  were computed by educational level (EL). Absolute differentials of LE 25  and DFLE 25  were calculated for each EL and for each period, as well as composite inequality indices (CII) of population-level impact of inequality. Changes over the 10-year period were then calculated for each inequality index.    Results  The LE 25  increased in all ELs and both genders, except in the lowest EL for women. The increase was larger in the highest EL, leading in 2011 to 6.07 and 4.58 years for the low-versus-high LE 25  gaps respectively in men and women, compared to 5.19 and 3.76 in 2001, namely 17 and 22% increases. The upwards shift of the EL distribution led to a limited 7% increase of the CII among men but no change in women.  The substantial increase of the DFLE 25  in males with high EL (+ 4.5 years) and the decrease of the DFLE 25  in women with low EL, results in a substantial increase of all considered DFLE 25  inequality measures in both genders. In 2011, DFLE 25  gaps were respectively 10.4 and 13.5 years in males and females compared to 6.51 and 9.30 in 2001, representing increases of 61 and 44% for the gaps, and 72 and 20% for the CII.    Conclusion  The LE 25  increased in all ELs, but at a higher pace in highly educated, leading to an increase in the LE 25  gaps in both genders. After accounting for the upwards shift of the educational distribution, the population-level inequality index increased only for men. The DFLE 25  increased only in highly educated men, and decreased in low educated women, leading to large increases of inequalities in both genders. A general plan to tackle health inequality should be set up, with particular efforts to improve the health of the low educated women.    Electronic supplementary material  The online version of this article (10.1186/s13690-019-0330-8) contains supplementary material, which is available to authorized users.

Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a census-based study