The fall and rise of US inequities in premature mortality: 1960-2002
The fall and rise of US inequities in premature mortality: 1960-2002
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DOI：
10.1371/journal.pmed.0050046
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发表时间：
2008-02-01
期刊：
影响因子：
15.8
通讯作者：
Kennedy, Malinda
中科院分区：
文献类型：
--
作者：
Krieger, Nancy;Rehkopf, David H.;Kennedy, Malinda
背景存在的争论是否，作为整体人口健康的改善，收入和种族/民族相关的健康差距的绝对和相对幅度必然增加或减少。因此，我们决定检验这一假设，即在死亡率下降的背景下，健康不公平现象扩大或缩小，通过检查美国42年期间的年度死亡率数据，方法和结果使用1960 -2002年的美国县死亡率数据和1960-2000年十年一次的人口普查的县家庭收入中位数数据，我们分析了过早死亡率（65岁以下人群的死亡率）和婴儿死亡率（1岁以下人群的死亡率），这些死亡率是按县平均家庭收入的五分位数（按县人口规模加权）计算的。在1960年至2002年期间，随着美国所有县收入五分位数的过早死亡率和婴儿死亡率的下降，在1966年至1980年期间，过早死亡率和婴儿死亡（相对和绝对）的社会经济和种族/民族不平等缩小，特别是对于美国有色人种;此后，相对健康不平等扩大，绝对差异几乎没有变化。所有的人都经历了相同的年年龄特异性过早死亡率的白色人口生活在收入最高的五分之一，1960年至2002年之间，14%的白色过早死亡和30%的过早死亡的color.ConclusionsThe观察到的趋势反驳论点，健康不公平不可避免地扩大或缩小人口健康状况的改善。相反，健康不平等的程度可能下降或上升;我们的工作是了解原因。
BackgroundDebates exist as to whether, as overall population health improves, the absolute and relative magnitude of income- and race/ethnicity-related health disparities necessarily increase-or derease. We accordingly decided to test the hypothesis that health inequities widen-or shrink-in a context of declining mortality rates, by examining annual US mortality data over a 42 year period.Methods and FindingsUsing US county mortality data from 1960-2002 and county median family income data from the 1960-2000 decennial censuses, we analyzed the rates of premature mortality ( deaths among persons under age 65) and infant death ( deaths among persons under age 1) by quintiles of county median family income weighted by county population size. Between 1960 and 2002, as US premature mortality and infant death rates declined in all county income quintiles, socioeconomic and racial/ethnic inequities in premature mortality and infant death ( both relative and absolute) shrank between 1966 and 1980, especially for US populations of color; thereafter, the relative health inequities widened and the absolute differences barely changed in magnitude. Had all persons experienced the same yearly age-specific premature mortality rates as the white population living in the highest income quintile, between 1960 and 2002, 14% of the white premature deaths and 30% of the premature deaths among populations of color would not have occurred.ConclusionsThe observed trends refute arguments that health inequities inevitably widen-or shrink - as population health improves. Instead, the magnitude of health inequalities can fall or rise; it is our job to understand why.