Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study
Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study
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DOI：
10.1016/s2468-2667(19)30219-1
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发表时间：
2020-01-01
影响因子：
50
通讯作者：
Hayward, Andrew
中科院分区：
文献类型：
--
作者：
Lewer, Dan;Jayatunga, Wikum;Hayward, Andrew
背景社会经济地位低与过早死亡风险增加相关。本研究的目的是衡量总规模的不平等过早死亡率为整个populationofEngland.Methods我们使用死亡率记录从英国国家统计局研究所有2465285过早死亡（定义为那些之前的年龄75岁）在英格兰之间的2003年1月1日和2018年12月31日。社会经济地位的定义使用的指数的十分位数的多重歧视：邻里收入，就业，教育水平，犯罪，健康，服务的可用性和当地环境的措施。我们通过将最贫困的十分位数的死亡率应用于其他十分位数，在年龄，性别和时间的分层中计算预期死亡人数。归因于社会经济不平等的死亡率被定义为观察到的死亡与预期死亡之间的差异。我们还使用寿命表模型来估计由于社会经济不平等而造成的寿命损失。（95%CI 35.3-35.9）的过早死亡归因于社会经济不平等，相当于877082例死亡，或每10分钟1例。（152 171例超额死亡）、呼吸道癌症（111 083例）和慢性阻塞性肺病（83 593例）。最不平等的死亡原因是结核病、阿片类药物使用、艾滋病毒、精神活性药物使用、病毒性肝炎和肥胖，每种原因都有三分之二以上归因于不平等。男子中的不平等现象更严重，在幼儿期和40-49岁达到高峰。在研究期间，由于不平等造成的死亡比例有所增加，特别是妇女，因为最贫困妇女的死亡率（不包括心血管疾病）趋于稳定，而某些疾病的死亡率有所增加。由于社会经济不平等，75岁之前的平均寿命损失了14.4个月。解读三分之一的过早死亡可归因于社会经济不平等，这是我们最重要的公共卫生挑战。应优先考虑解决健康上游决定因素的干预措施。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England.Methods We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality.Findings 35.6% (95% CI 35.3-35.9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40-49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14.4 months of life before age 75 years are lost due to socioeconomic inequality. Interpretation One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge.Interventions that address upstream determinants of health should be prioritised. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.