Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data.
Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data.
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DOI：
10.1016/s0140-6736(17)30187-3
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发表时间：
2017-03-11
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影响因子：
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通讯作者：
Berrington de Gonzalez A
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作者：
Shiels MS;Chernyavskiy P;Anderson WF;Best AF;Haozous EA;Hartge P;Rosenberg PS;Thomas D;Freedman ND;Berrington de Gonzalez A
减少过早死亡率是联合国可持续发展目标。与其他高收入国家不同，美国的年龄调整死亡率在 2010 年趋于稳定，并在 2015 年略有上升，这可能是因为过早死亡率上升。我们的目的是按年龄组、性别、种族和民族分析 1999 年至 2014 年间美国 25-64 岁人群的死亡率趋势，并确定时间趋势背后的具体死亡原因。在这项分析中，我们使用了美国国家卫生统计中心死亡证明中的死因和人口数据以及美国人口普查局的人口估计。我们使用年龄-时期-队列模型估计了死亡率的年度百分比变化。 2000 年至 2014 年的年龄标准化超额死亡人数是用观测死亡人数减去预期死亡人数（根据 1999 年死亡率估算）得出的。 1999 年至 2014 年间，白人、美洲印第安人和阿拉斯加原住民的过早死亡率有所增加。女性和 25-30 岁年龄段的增幅最高。在 30 岁人群中，白人女性的年死亡率增加为 2·3% (95% CI 2·1–2·4)，白人男性为 0·6% (0·5–0·7)，美洲印第安人和阿拉斯加原住民女性和男性的年死亡率分别为 4·3% (3·5–5·0) 和 1·9% (1·3–2·5)。这些增加主要归因于意外死亡（主要是药物中毒）、慢性肝病和肝硬化以及自杀。 2000-14 年间，在 25-49 岁的人群中，估计有 111 000 例白人过早死亡，6600 例美洲印第安人和阿拉斯加原住民过早死亡。相比之下，西班牙裔（每年高达 3·2%）、黑人（每年高达 3·9%）以及亚裔和太平洋岛民（每年高达 2·6%）的过早死亡率大幅下降，这主要是因为艾滋病毒、癌症和心脏病死亡人数的下降，预计导致西班牙裔死亡人数减少 112 000 人，黑人死亡人数减少 311 000 人，黑人死亡人数减少 34 万人。 25-64 岁的亚洲人和太平洋岛民的死亡人数减少了 000 人。 2011-14 年期间，美洲印第安人和阿拉斯加原住民的过早死亡率最高，其次是黑人。重要的公共卫生成功，包括艾滋病毒治疗和戒烟，有助于降低西班牙裔、黑人、亚洲人和太平洋岛民的过早死亡率。然而，这一进步在年轻和中年（25-49岁）白人、美洲印第安人和阿拉斯加原住民中基本上被否定了，主要是因为药物中毒、自杀、慢性肝病和肝硬化等潜在可避免的原因。美国每年死亡率增加的幅度在高收入国家中极为不寻常，需要采取快速的公共卫生应对措施来避免进一步的过早死亡。美国国家癌症研究所校内研究计划。
Reduction of premature mortality is a UN Sustainable Development Goal. Unlike other high-income countries, age-adjusted mortality in the USA plateaued in 2010 and increased slightly in 2015, possibly because of rising premature mortality. We aimed to analyse trends in mortality in the USA between 1999 and 2014 in people aged 25–64 years by age group, sex, and race and ethnicity, and to identify specific causes of death underlying the temporal trends. For this analysis, we used cause-of-death and demographic data from death certificates from the US National Center for Health Statistics, and population estimates from the US Census Bureau. We estimated annual percentage changes in mortality using age-period-cohort models. Age-standardised excess deaths were estimated for 2000 to 2014 as observed deaths minus expected deaths (estimated from 1999 mortality rates). Between 1999 and 2014, premature mortality increased in white individuals and in American Indians and Alaska Natives. Increases were highest in women and those aged 25–30 years. Among 30-year-olds, annual mortality increases were 2·3% (95% CI 2·1–2·4) for white women, 0·6% (0·5–0·7) for white men, and 4·3% (3·5–5·0) and 1·9% (1·3–2·5), respectively, for American Indian and Alaska Native women and men. These increases were mainly attributable to accidental deaths (primarily drug poisonings), chronic liver disease and cirrhosis, and suicide. Among individuals aged 25–49 years, an estimated 111 000 excess premature deaths occurred in white individuals and 6600 in American Indians and Alaska Natives during 2000–14. By contrast, premature mortality decreased substantially across all age groups in Hispanic individuals (up to 3·2% per year), black individuals (up to 3·9% per year), and Asians and Pacific Islanders (up to 2·6% per year), mainly because of declines in HIV, cancer, and heart disease deaths, resulting in an estimated 112 000 fewer deaths in Hispanic individuals, 311 000 fewer deaths in black individuals, and 34 000 fewer deaths in Asians and Pacific Islanders aged 25–64 years. During 2011–14, American Indians and Alaska Natives had the highest premature mortality, followed by black individuals. Important public health successes, including HIV treatment and smoking cessation, have contributed to declining premature mortality in Hispanic individuals, black individuals, and Asians and Pacific Islanders. However, this progress has largely been negated in young and middle-aged (25–49 years) white individuals, and American Indians and Alaska Natives, primarily because of potentially avoidable causes such as drug poisonings, suicide, and chronic liver disease and cirrhosis. The magnitude of annual mortality increases in the USA is extremely unusual in high-income countries, and a rapid public health response is needed to avert further premature deaths. US National Cancer Institute Intramural Research Program.