Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations
Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations
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DOI：
10.1016/s0140-6736(05)17867-2
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发表时间：
2005-02-05
期刊：
影响因子：
168.9
通讯作者：
Mackenbach, JP
中科院分区：
文献类型：
--
作者：
Huisman, M;Kunst, AE;Mackenbach, JP
背景：对死因模式的社会经济差异的研究仅限于单一国家、中年人、男性或广泛的死因群体。我们评估了具体的死亡原因的贡献，死亡率的差异与不同教育水平的群体之间，在男性和女性，中年和老年人，在8个西欧population.Methods我们分析了纵向死亡率研究的死亡原因，1990年1月1日至1997年12月31日之间的数据。数据包括超过100万例死亡51万人年observation.Findings绝对教育不平等的总死亡率达到峰值，每10万人年男性2127例死亡，每10万人年女性1588例死亡，年龄在75岁及以上。在这一年龄组中，总死亡率和除男性前列腺癌和女性肺癌外的所有具体死亡原因的比率均大于1 - 00，表明低学历组的死亡率高于高学历组。在男性中，心血管疾病占低教育程度群体和高教育程度群体总死亡率差异的39%，癌症占24%，其他疾病占32%，外因占5%。在妇女中，贡献率分别为60%、11%、30%和0%。脑血管疾病、其他心血管疾病、肺炎和慢性阻塞性肺病的发病率随年龄增长而显著增加，而癌症和外部原因的发病率则下降。虽然总死亡率的相对不平等在所有人群中非常相似，但我们注意到，在具体原因对这些不平等的贡献方面存在显着差异。解释研究需要扩大，以包括老年人口，其他疾病和欧洲不同地区的人口。应制定和实施有效的干预措施，以减少受教育程度低的群体暴露于心血管危险因素。
Background Studies of socioeconomic disparities in patterns of cause of death have been limited to single countries, middle-aged people, men, or broad cause of death groups. We assessed contribution of specific causes of death to disparities in mortality between groups with different levels of education, in men and women, middle-aged and old, in eight western European populations.Methods We analysed data from longitudinal mortality studies by cause of death, between Jan 1, 1990, and Dec 31, 1997. Data were included for more than 1 million deaths in 51 million person years of observation.Findings Absolute educational inequalities in total mortality peaked at 2127 deaths per 100 000 person years in men, and at 1588 deaths per 100 000 person years in women aged 75 years and older. In this age-group, rate ratios were greater than 1 - 00 for total mortality and all specific causes of death, apart form prostate cancer in men and lung cancer in women, showing increased mortality in low versus high eductational groups. In men, cardiovascular diseases accounted for 39% of the difference between low and high eductational groups in total mortality, cancer for 24%, other diseases for 32%, and external causes for 5%. Among women, contributions were 60%, 11%, 30%, and 0%, respectively. The contributions of cerebrovascular disease, other cardiovascular diseases, pneumonia, and COPD strongly increased by age, whereas those of cancer and external causes declined. Although relative inequalities in total mortality were closely similar in all populations, we noted striking differences in the contribution of specific causes to these inequalities.Interpretation Research needs to be broadened to include older populations, other diseases, and populations from different parts of Europe. Effective interventions should be developed and implemented to reduce exposure to cardiovascular risk factors in low-educational groups.