Income differences in mortality:: a register-based follow-up study of three million men and women
Income differences in mortality:: a register-based follow-up study of three million men and women
复制标题
DOI：
10.1093/ije/30.6.1397
复制
发表时间：
2001-12-01
影响因子：
7.7
通讯作者：
Valkonen, T
中科院分区：
文献类型：
--
作者：
Martikainen, P;Mäkelä, P;Valkonen, T
目的我们分析家庭净收入和死亡率之间的关系是否形成一个连续的线性梯度或曲线，评估调整混杂和反向因果关系后，这种关联的衰减，并评估年龄和死因的关联强度。关于家庭收入和社会人口因素的资料来自芬兰税务当局的记录和1990年人口普查。超过95%的同龄人都有收入数据。结果1991-1996年，最低收入阶层与最高收入阶层的全因死亡率之比男性为2.37（95%CI：2.30-2.44），女性为133（95%CI：1.67-1.80）。根据家庭结构、配偶的经济活动、社会阶层、教育和自己的经济活动进行调整后，男性和女性的关系分别减弱了61%和52%。调整混杂因素前后，收入与死亡率之间的关系主要是线性的，在60-64岁以下的所有5岁年龄组中，这种关系都很强，之后这种关系的强度迅速下降。这种关系的年龄模式表明，这种关系的很大一部分不太可能是由于贫穷和物质困难的直接因果影响。相反，收入似乎与在整个收入范围内增加死亡率的因素的积累有关。
Objectives We analyse whether the relationship between net household income and mortality form a continuous linear gradient or is curvilinear, assess the attenuation of this association after adjusting for confounding and reverse causality, and assess the strength of the association by age and cause of death.Design and Prospective study of mortality in Finland among all men and women over setting 30 years old. Information on household income and sociodemographic factors was from the records of the Finnish tax authorities and the 1990 census. Income data were available for more than 95% of the cohort. Follow-up was by record linkage to death certificates in 1991-1996; altogether about 261 000 deaths.Results The all-cause mortality ratio between the lowest and the highest household income decile is 2.37 (95% CI: 2.30-2.44) among men and 133 (95% CI: 1.67-1.80) among women. Adjusting for household structure, spouse's economic activity, social class, education and own economic activity attenuates the relationship by 61% among men and 52% among women. The association between income and mortality is mainly linear before and after adjusting for confounding, and the association is strong for all 5-year age groups below 60-64 years, after which it declines rapidly in strength.Conclusions The mainly linear nature of the relationship and the strong attenuation after adjustment for other socioeconomic factors and economic activity status, and the age pattern of the relationship indicate that a large part of the relationship is unlikely to be due to direct causal effects of poverty and material hardship. Rather, income seems to be related to accumulation of factors that increase mortality over the whole range of incomes.