Patterns of mortality by occupation in the UK, 1991-2011: a comparative analysis of linked census and mortality records
Patterns of mortality by occupation in the UK, 1991-2011: a comparative analysis of linked census and mortality records
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DOI：
10.1016/s2468-2667(17)30193-7
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发表时间：
2017-11-01
影响因子：
50
通讯作者：
Stuckler, David
中科院分区：
文献类型：
--
作者：
Katikireddi, Srinivasa Vittal;Leyland, Alastair H.;Stuckler, David
背景：按职业分类的死亡率的详细评估很少。我们的目的是评估死亡率在英国的职业，在英格兰和威尔士和苏格兰之间的差异率，并随着时间的推移在Scotland.Methods我们分析了成年人的工作年龄（20-59岁）使用链接的人口普查和死亡记录。在2001年的人口普查中，主要职业被编码为60多个组，死亡率随访至2011年12月31日。1991年苏格兰有可比的职业数据，可以评估一段时间内的趋势。我们计算了按性别分层的年龄标准化全因死亡率（每10万人-年）。我们使用蒙特卡罗模拟得出的p值和95%的置信区间的死亡率随时间的差异，英格兰和威尔士和Scotland.Findings在451万人年的后续行动，职业的死亡率不同的最低和最高观察到的男性和女性之间的三倍以上。在英格兰和威尔士的男性中，卫生专业人员的死亡率最低（每10万人年225例死亡[95% CI 145-304]），管理人员和教师的死亡率也较低。死亡率最高的是基础建设（701例死亡/10万人年[95% CI 593-809]），以及家政和工厂工人。在妇女中，教师和商业专业人员的死亡率较低，工厂工人和服装贸易工人的死亡率较高。死亡率总体上有所下降，但在某些职业中，例如清洁工，女性的死亡率停滞不前，甚至有所上升（1991年每10万人年有337人死亡[95%CI 292-382]，2001年上升至每10万人年有426人死亡[371-481]）。模拟模型的结果表明，如果将英格兰和威尔士的职业死亡率应用于苏格兰，苏格兰每年将减少631名男性（95% CI 285-979;下降9.7%）和273名女性（26-513;下降6.7%）。在苏格兰，过多的死亡集中在低技能职业（如，女清洁工）。苏格兰的高死亡率集中在低技能工人中，尽管大多数职业群体的男女死亡率有所改善，但有些群体的死亡率有所上升。今后在详细的职业一级调查死亡的具体原因的研究将是有价值的，特别是为了了解不稳定就业对健康的影响和改善非常具体的职业群体的工作条件的必要性。版权（C）作者。由Elsevier Ltd.发布，这是CC BY 4.0许可下的黄金开放获取文章。
Background Detailed assessments of mortality by occupation are scarce. We aimed to assess mortality by occupation in the UK, differences in rates between England and Wales and Scotland, and changes over time in Scotland.Methods We analysed adults of working age (20-59 years) using linked census and death records. Main occupation was coded into more than 60 groups in the 2001 census, with mortality follow-up until Dec 31, 2011. Comparable occupation data were available for Scotland in 1991, allowing assessment of trends over time. We calculated age-standardised all-cause mortality rates (per 100 000 person-years), stratified by sex. We used Monte Carlo simulation to derive p values and 95% CIs for the difference in mortality over time and between England and Wales and Scotland.Findings During 4.51 million person-years of follow-up, mortality rates by occupation differed by more than three times between the lowest and highest observed rates in both men and women. Among men in England and Wales, health professionals had the lowest mortality (225 deaths per 100 000 person-years [95% CI 145-304]), with low rates also shown in managers and teachers. The highest mortality rates were in elementary construction (701 deaths per 100 000 person-years [95% CI 593-809]), and housekeeping and factory workers. Among women, teachers and business professionals had low mortality, and factory workers and garment trade workers had high rates. Mortality rates have generally fallen, but have stagnated or even increased among women in some occupations, such as cleaners (337 deaths per 100 000 person years [95% CI 292-382] in 1991, rising to 426 deaths per 100 000 person years in 2001 [371-481]). Findings from simulation models suggested that if mortality rates by occupation in England and Wales applied to Scotland, 631 fewer men (95% CI 285-979; a 9.7% decrease) and 273 fewer women (26-513; 6.7% decrease) of working age would die in Scotland every year. Excess deaths in Scotland were concentrated among lower skilled occupations (eg, female cleaners).Interpretation Mortality rates differ greatly by occupation. The excess mortality in Scotland is concentrated among low-skilled workers and, although mortality has improved in men and women in most occupational groups, some groups have experienced increased rates. Future research investigating the specific causes of death at the detailed occupational level will be valuable, particularly with a view to understanding the health implications of precarious employment and the need to improve working conditions in very specific occupational groups. Copyright (c) The Author(s). Published by Elsevier Ltd. This is a Gold Open Access article under the CC BY 4.0 license.