THE INCREASING DISPARITY IN MORTALITY BETWEEN SOCIOECONOMIC GROUPS IN THE UNITED-STATES, 1960 AND 1986
THE INCREASING DISPARITY IN MORTALITY BETWEEN SOCIOECONOMIC GROUPS IN THE UNITED-STATES, 1960 AND 1986
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DOI：
10.1056/nejm199307083290207
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发表时间：
1993-07-08
影响因子：
158.5
通讯作者：
FISHER, G
中科院分区：
文献类型：
--
作者：
PAPPAS, G;QUEEN, S;FISHER, G
背景社会经济地位与死亡率之间存在反比关系。在过去的几十年里，美国的死亡率有所下降，但目前还不清楚是否所有社会经济群体都平等受益。利用1986年全国死亡率追踪调查（n = 13，491）和1986年全国健康访谈调查（n = 30，725）的记录，我们重复了Kitagawa和豪瑟对1960年差异死亡率的分析。我们根据种族、性别、收入和家庭状况计算了25至64岁人群的直接标准化死亡率和间接标准化死亡率。1986年死亡率与社会经济地位之间的反比关系持续存在，而且比1960年更强。男女之间、白人和黑人之间、家庭成员和无关人员之间的死亡率差异因收入和教育程度而有所扩大。在26年期间，白人和黑人受教育程度的不平等增加了20%以上，男性增加了100%以上。在白人中，所有教育水平的人的绝对死亡率都有所下降，但受教育程度较高的男性和女性的下降幅度大于受教育程度较低的男性和女性。 尽管自1960年以来美国的死亡率总体上有所下降，但穷人和受教育程度低的人的死亡率仍然高于收入较高或受教育程度较高的人，而且这种差距在1960年至1986年期间有所扩大。
Background. There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally.Methods. Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status.Results. The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 1 00 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less.Conclusions. Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.