Unequal Trends in Coronary Heart Disease Mortality by Socioeconomic Circumstances, England 1982-2006: An Analytical Study
Unequal Trends in Coronary Heart Disease Mortality by Socioeconomic Circumstances, England 1982-2006: An Analytical Study
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DOI：
10.1371/journal.pone.0059608
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发表时间：
2013-03-20
期刊：
影响因子：
3.7
通讯作者：
Capewell, Simon
中科院分区：
文献类型：
--
作者：
Bajekal, Madhavi;Scholes, Shaun;Capewell, Simon
背景资料：冠心病（CHD）仍然是一个主要的公共卫生负担，每年在英格兰和威尔士造成80，000人死亡，存在严重的不平等。然而，最近没有对按年龄划分的死亡率社会经济趋势进行分析。我们分析了每年的趋势，在英格兰的小地区，分组为剥夺quintiles. Methods年龄别冠心病死亡率的不平等：我们计算了冠心病死亡率为10年的年龄组（从35岁到>= 85岁），使用三年移动平均值在1982年和2006年之间。我们使用Joinpoint回归来确定年龄性别和剥夺特定时间趋势的重要转折点。我们还分析了绝对和相对不平等的趋势，年龄标准化率之间的最少和最贫困的areas.Results：1982年至2006年，冠心病死亡率下降了62.2%，男性和59.7%的女性。福尔斯下降幅度最大的是最贫困的地区，这些地区的冠心病死亡率最高。然而，下降速度的社会梯度是明显的，在最贫穷的五分之一人口中最陡。因此，虽然绝对不平等在此期间有所缩小，但相对不平等有所增加。从2000年起，最年轻群体的死亡率下降速度减缓或趋于平稳，特别是最贫困群体中45 - 54岁的妇女。相比之下，从55岁及以上，冠心病死亡率的下降速度加快，在2000年代，同样下降最快的最贫困的五分之一。结论：标准化的冠心病死亡率大幅下降，在英格兰，最陡峭的福尔斯在最富裕的五分之一。然而，这掩盖了按年龄划分的基本比率的对比模式。从2000年起，最年轻群体的死亡率趋于平稳，但中年和老年群体的死亡率则加速上升。小地区的死亡率分析可以提供潜在的有价值的见解不平等的可能驱动因素，从而为未来的战略，以减少所有社会群体的冠心病死亡率。
Background: Coronary heart disease (CHD) remains a major public health burden, causing 80,000 deaths annually in England and Wales, with major inequalities. However, there are no recent analyses of age-specific socioeconomic trends in mortality. We analysed annual trends in inequalities in age-specific CHD mortality rates in small areas in England, grouped into deprivation quintiles.Methods: We calculated CHD mortality rates for 10-year age groups (from 35 to >= 85 years) using three year moving averages between 1982 and 2006. We used Joinpoint regression to identify significant turning points in age-sex-and deprivation-specific time trends. We also analysed trends in absolute and relative inequalities in age-standardised rates between the least and most deprived areas.Results: Between 1982 and 2006, CHD mortality fell by 62.2% in men and 59.7% in women. Falls were largest for the most deprived areas with the highest initial level of CHD mortality. However, a social gradient in the pace of fall was apparent, being steepest in the least deprived quintile. Thus, while absolute inequalities narrowed over the period, relative inequalities increased. From 2000, declines in mortality rates slowed or levelled off in the youngest groups, notably in women aged 45-54 in the least deprived groups. In contrast, from age 55 years and older, rates of fall in CHD mortality accelerated in the 2000s, likewise falling fastest in the least deprived quintile.Conclusions: Age-standardised CHD mortality rates have declined substantially in England, with the steepest falls in the most affluent quintiles. However, this concealed contrasting patterns in underlying age-specific rates. From 2000, mortality rates levelled off in the youngest groups but accelerated in middle aged and older groups. Mortality analyses by small areas could provide potentially valuable insights into possible drivers of inequalities, and thus inform future strategies to reduce CHD mortality across all social groups.