Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America
Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America
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DOI：
10.1016/s0140-6736(06)68975-7
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发表时间：
2006-07-01
期刊：
影响因子：
168.9
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Jha, Prabhat;Peto, Richard;Lopez, Alan D.
背景在许多国家，成年男性死亡率存在严重的社会不平等。吸烟通常在社会阶层、教育程度或收入较低的男性中更为普遍。吸烟的贡献，这些社会不平等的mortality.Methods的贡献，吸烟对成人死亡率的人口可以间接估计，从疾病的具体死亡率在人口（使用绝对肺癌率，以表示比例，由于吸烟的死亡率从某些其他疾病）。我们将这些方法应用于1996年四个国家三个不同社会阶层35-69岁男性的死亡率，基于总共60万例死亡。最高和最低的社会阶层是基于社会阶级（专业与非熟练手工）在英格兰和威尔士，邻里收入（顶部与底部五分之一），并完成教育年数（大于或小于12年）。结果在每个国家，在35-69岁的男性中，最高和最低社会阶层之间的死亡总风险约为两倍（英格兰和威尔士21%对43%，美国20%对37%，加拿大21%对34%，波兰26%对50%：四国平均值22%对41%，四国平均绝对差异19%）。社会顶层和底层之间死亡率差异的一半以上涉及35-69岁吸烟死亡风险的差异（英格兰和威尔士4%对19%，美国4%对15%，加拿大6%对13%，波兰5%对22%：四国平均5%对17%，四国平均绝对差异12%）。吸烟导致的死亡率占男性总死亡率的近一半，在最低的社会阶层的每个国家.Conclusion在这些人群中，大多数，但不是全部，在20世纪90年代的成年男性死亡率的实质性社会不平等是由于吸烟的影响。广泛戒烟最终可以将这些社会阶层之间过早死亡风险的绝对差异减半。
Background There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain.Methods The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland.Results In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21% vs 43%, USA 20% vs 37%, Canada 21% vs 34%, Poland 26% vs 50%: four-country mean 22% vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4% vs 19%, USA 4% vs 15%, Canada 6% vs 13%, Poland 5% vs 22%: four-country mean 5% vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country.Conclusion In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.