Long-term association of economic inequality and mortality in adult Costa Ricans.
Long-term association of economic inequality and mortality in adult Costa Ricans.
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经济不平等与成年哥斯达黎加人死亡率的长期关联。
DOI：
10.1016/j.socscimed.2011.10.034
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Rosero-Bixby,Luis
中科院分区：
文献类型：
--
作者：
Modrek,Sepideh;Dow,WilliamH;Rosero-Bixby,Luis
尽管进行了大量研究（主要是在发达经济体），但对不平等对健康的影响的共识有限。近年来，相关文献研究了相对剥夺与健康之间的关系，作为解释经济不平等与健康关系的机制。本研究在中等收入国家哥斯达黎加的背景下，评估了死亡率和经济不平等之间的关系，通过区域一级基尼系数来衡量，以及死亡率和相对剥夺之间的关系。我们跟踪了一个具有全国代表性的前瞻性队列，大约有16,000名30岁及以上的人，他们是从1984年人口普查中随机抽取的。然后将这些人与哥斯达黎加国家死亡登记处联系起来，直到2007年12月31日。风险模型用于估计全因死亡率和心血管疾病死亡率的两个指标的相对风险：州一级的收入不平等和基于资产所有权的相对剥夺。结果表明，州收入不平等与死亡率之间存在出乎意料的负相关关系，但在纳入州固定效应后，这种关系并不稳健。相比之下，我们发现相对剥夺与死亡率之间存在正相关，这对于包括广州固定效应是稳健的。综上所述，这些结果表明，在哥斯达黎加的情况下，相对于等级较高的人而言，剥夺比等级本身的整体分散对健康的危害更大。
Despite the large number of studies, mostly in developed economies, there is limited consensus on the health effects of inequality. Recently a related literature has examined the relationship between relative deprivation and health as a mechanism to explain the economic inequality and health relationship. This study evaluates the relationship between mortality and economic inequality, as measured by area-level Gini coefficients, as well as the relationship between mortality and relative deprivation, in the context of a middle-income country, Costa Rica. We followed a nationally representative prospective cohort of approximately 16,000 individuals aged 30 and over who were randomly selected from the 1984 census. These individuals were then linked to the Costa Rican National Death Registry until Dec. 31, 2007. Hazard models were used to estimate the relative risk of mortality for all-cause and cardiovascular disease mortality for two indicators: canton-level income inequality and relative deprivation based on asset ownership. Results indicate that there was an unexpectedly negative association between canton income inequality and mortality, but the relationship is not robust to the inclusion of canton fixed-effects. In contrast, we find a positive association between relative deprivation and mortality, which is robust to the inclusion of canton fixed-effects. Taken together, these results suggest that deprivation relative to those higher in a hierarchy is more detrimental to health than the overall dispersion of the hierarchy itself, within the Costa Rican context.