The effects of regional characteristics on alcohol-related mortality -: a register-based multilevel analysis of 1.1 million men
The effects of regional characteristics on alcohol-related mortality -: a register-based multilevel analysis of 1.1 million men
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DOI：
10.1016/j.socscimed.2003.09.027
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发表时间：
2004-06-01
影响因子：
5.4
通讯作者：
Valkonen, T
中科院分区：
文献类型：
--
作者：
Blomgren, J;Martikainen, P;Valkonen, T
本研究的目的是评估在何种程度上选择功能区的特点影响酒精相关的死亡率在芬兰男性调整后的个人水平的特点。该研究是作为一个多层次的泊松回归分析，个人（n = 110万）作为第一级和芬兰的功能区（n = 84）作为第二级。分析对象为25-64岁的男性。这些数据是根据1990年的人口普查记录，并与1991-1996年的死亡记录相联系。结果测量是酒精相关的死亡率，这是使用死亡的潜在和促成原因的信息定义的。个体水平的协变量包括年龄、教育、社会经济状况、婚姻状况和母语。考虑的地区一级变量是体力劳动者的比例、失业水平、家庭收入中位数、收入基尼系数、家庭凝聚力、投票率、城市化水平和讲瑞典语的居民比例。高比例的体力劳动者和失业者和低社会凝聚力（家庭凝聚力和投票率）被认为对酒精相关的死亡率产生不利影响，这些变量的独立影响在调整所有个人层面和地区层面的特征后仍然存在。高水平的城市化的保护作用后，其他个人和地区层面的特征调整。无论是平均收入还是收入不平等都与酒精相关的死亡率无关。调整个人水平变量后，各功能区酒精相关死亡率的平均相对偏差减少了41%。在模型中纳入区域一级的特点，导致总减少79%的变化。本研究中考虑的区域特征对酒精相关死亡率有显著影响，尽管这些影响小于个体水平特征的影响。需要更充分地了解区域社会结构和凝聚力措施对危险酒精消费和酒精相关死亡率影响的机制。(C)2003 Elsevier Ltd.保留所有权利。
The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n = 1.1 million) as the first level and functional regions of Finland (n = 84) as the second level. The analysis covered men aged 25-64. The data are based on the 1990 census records, which were linked to death records in 1991-1996. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. The individual-level covariates included age, education, socioeconomic status, marital status and mother tongue. The area-level variables considered were the proportion of manual workers, unemployment level, median household income, Gini coefficient of income, family cohesion, voting turnout, level of urbanisation and proportion of Swedish-speaking inhabitants. A high proportion of manual workers and of unemployed and low social cohesion (family cohesion and voting turnout) were found to produce adverse effects on alcohol-related mortality, and the independent effects of these variables remained after adjustment for all individual-level and area-level characteristics. The protective effect of high level of urbanisation was revealed after adjustment for other individual- and area-level characteristics. Neither mean income nor income inequality were related to alcohol-related mortality. Adjusting for individual-level variables diminished the average relative deviation of alcohol-related mortality among the functional regions by 41%. The inclusion of area-level characteristics in the model resulted in a total diminution of variation of 79%. The area characteristics considered in this study had a notable effect on alcohol-related mortality, although these effects were smaller than those of the individual-level characteristics. Fuller understanding of the mechanisms underlying the effects of area measures of social structure and cohesion on risky alcohol consumption and alcohol-related mortality is needed. (C) 2003 Elsevier Ltd. All rights reserved.