Inequalities in premature mortality in Britain: observational study from 1921 to 2007
Inequalities in premature mortality in Britain: observational study from 1921 to 2007
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DOI：
10.1136/bmj.c3639
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发表时间：
2010-07-22
影响因子：
105.7
通讯作者：
Smith, George Davey
中科院分区：
文献类型：
--
作者：
Thomas, Bethan;Dorling, Danny;Smith, George Davey
目的 报告英国不同地理区域过早死亡的不平等程度。设计对常规收集的死亡率数据和公共记录进行观察性研究。按年龄、性别和地理区域细分的人口（1991年至2007年的议会选区，1974年之前较长时间跨度的地方当局）。设置英国。参与者1990年至2007年75岁以下的全部人口，以及1921-39年、1950-3年期间65岁以下的全部人口， 1959-63年、1969-73年和1981-2007年。主要结果指标不平等相对指数（RII）以及75岁和65岁以下年龄-性别标准化死亡率的不平等比率。不平等相对指数是假设社会经济地位与死亡风险之间存在线性关联的情况下，假设社会经济地位与假设最好的人相比，人口中假设最穷的人的相对死亡率。不平等比率是最贫困人口10%的标准化死亡率与最贫困人口10%的标准化死亡率之比。结果以相对不平等指数衡量时，75岁以下年龄性别标准化死亡率的地理不平等从1990-1年到2006-7年每两年增加一次，无一例外。在此期间，不平等的相对指数从1990-1年的1.61（95%置信区间1.52至1.69）上升至2006-7年的2.14（2.02至2.27）。简单比率表明，在 2001 年左右的一段短暂时期内，不平等现象略有减少，但这种情况很快就被逆转，75 岁以下的不平等现象现已达到至少 1990 年以来报告的最高水平。同样，65 岁以下死亡率的不平等现象在本世纪初略有改善，但最新数据超过了先前报告的最极端水平。对历史记录中 65 岁以下人群的粗略年龄-性别标准化率进行比较表明，最近十年中死亡率的地理不平等程度高于至少自 1921 年以来有记录的任何类似时期。结论 在 21 世纪的第一个十年中，英国地区之间的过早死亡率不平等现象继续稳步上升。在漫长的经济记录中，上一次不平等程度几乎达到如此之高是在 1929 年经济崩溃和 1930 年代经济萧条之前。 2008 年的经济崩溃可能会导致英国地区之间死亡率出现更大的不平等。
Objective To report on the extent of inequality in premature mortality as measured between geographical areas in Britain.Design Observational study of routinely collected mortality data and public records. Population subdivided by age, sex, and geographical area (parliamentary constituencies from 1991 to 2007, pre-1974 local authorities over a longer time span).Setting Great Britain.Participants Entire population aged under 75 from 1990 to 2007, and entire population aged under 65 in the periods 1921-39, 1950-3, 1959-63, 1969-73, and 1981-2007.Main outcome measure Relative index of inequality (RII) and ratios of inequality in age-sex standardised mortality ratios under ages 75 and 65. The relative index of inequality is the relative rate of mortality for the hypothetically worst-off compared with the hypothetically best-off person in the population, assuming a linear association between socioeconomic position and risk of mortality. The ratio of inequality is the ratio of the standardised mortality ratio of the most deprived 10% to the least deprived 10%.Results When measured by the relative index of inequality, geographical inequalities in age-sex standardised rates of mortality below age 75 have increased every two years from 1990-1 to 2006-7 without exception. Over this period the relative index of inequality increased from 1.61 (95% confidence interval 1.52 to 1.69) in 1990-1 to 2.14 (2.02 to 2.27) in 2006-7. Simple ratios indicated a brief period around 2001 when a small reduction in inequality was recorded, but this was quickly reversed and inequalities up to the age of 75 have now reached the highest levels reported since at least 1990. Similarly, inequalities in mortality ratios under the age of 65 improved slightly in the early years of this century but the latest figures surpass the most extreme previously reported. Comparison of crudely age-sex standardised rates for those below age 65 from historical records showed that geographical inequalities in mortality are higher in the most recent decade than in any similar time period for which records are available since at least 1921.Conclusions Inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.