Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data
Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data
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DOI：
10.1016/s2468-2667(18)30214-7
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发表时间：
2018-12-01
影响因子：
50
通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
--
作者：
Bennett, James E.;Pearson-Stuttard, Jonathan;Ezzati, Majid
背景 自 20 世纪 80 年代以来，英国的预期寿命不平等现象稳步加剧。我们的目的是调查不同疾病和伤害以及不同年龄段的死亡人数对死亡人数的上升有多少贡献，为旨在减少健康不平等的政策提供信息。方法我们使用了英国国家统计局关于2001年至2016年英国人口和死亡的重要登记数据，按根本死因，按性别、5岁年龄组和多重剥夺指数的十分位数分层（基于2017年英格兰低超产出地区的排名分数）。 2015）。我们根据指定的国际疾病分类（第十版）代码对 765 万人进行了分组，以创建公共卫生和临床相关性的类别。我们使用贝叶斯分层模型来获得按性别、年龄组、年份和剥夺十分位数划分的特定原因死亡率的稳健估计。我们使用生命表方法按剥夺十分之一和年份计算了出生时的预期寿命。我们使用 Arriaga 方法计算了每个 5 岁年龄组中每种疾病和伤害造成的死亡对最贫困和最富裕十分位之间预期寿命差距的贡献。结果 最富裕和最贫困十分位之间的预期寿命差距从 2001 年的 6.1 岁（95% 可信区间 5.9-6.2）增加到 2001 年的 7.9 年（7.7-8.1）。 2016 年，女性年龄从 9.0 岁 (8.8-9.2) 提高到 9.7 岁 (9.6-9.9)。自 2011 年以来，第三、第四和第五最贫困十分位的女性预期寿命增长停滞，而两个最贫困十分位的女性预期寿命则出现逆转，到 2016 年，最贫困的十分位女性预期寿命下降了 0.24 岁（0.10-0.37），第二贫困的女性预期寿命下降了 0.16 岁（0.02-0.29）。 2016 年，贫困地区的人口比例高于富裕地区。造成预期寿命不平等的最大因素是 5 岁以下儿童的死亡（主要是新生儿死亡）、工作年龄的呼吸系统疾病、缺血性心脏病、肺癌和消化道癌症以及老年痴呆症。从 2001 年到 2016 年，5 岁以下儿童死亡、缺血性心脏病（男女）、中风和故意伤害（男性）对不平等的影响有所下降，但大多数其他原因造成的不平等有所增加。 英格兰预期寿命的最新趋势不仅导致了不平等的扩大，而且最贫困社区的预期寿命现在没有增加。这些不平等是由多种可以有效预防和治疗的疾病造成的。在预防、健康和社会关怀方面采用比例普遍主义原则可以将所有社区的死亡推迟到老年，并减少预期寿命不平等。版权所有 (C) 2018 作者。由爱思唯尔有限公司出版
Background Life expectancy inequalities in England have increased steadily since the 1980s. Our aim was to investigate how much deaths from different diseases and injuries and at different ages have contributed to this rise to inform policies that aim to reduce health inequalities.Methods We used vital registration data from the Office for National Statistics on population and deaths in England, by underlying cause of death, from 2001 to 2016, stratified by sex, 5-year age group, and decile of the Index of Multiple Deprivation (based on the ranked scores of Lower Super Output Areas in England in 2015). We grouped the 7.65 million deaths by their assigned International Classification of Diseases (10th revision) codes to create categories of public health and clinical relevance. We used a Bayesian hierarchical model to obtain robust estimates of cause-specific death rates by sex, age group, year, and deprivation decile. We calculated life expectancy at birth by decile of deprivation and year using life-table methods. We calculated the contributions of deaths from each disease and injury, in each 5-year age group, to the life expectancy gap between the most deprived and affluent deciles using Arriaga's method.Findings The life expectancy gap between the most affluent and most deprived deciles increased from 6.1 years (95% credible interval 5.9-6.2) in 2001 to 7.9 years (7.7-8.1) in 2016 in females and from 9.0 years (8.8-9.2) to 9.7 years (9.6-9.9) in males. Since 2011, the rise in female life expectancy has stalled in the third, fourth, and fifth most deprived deciles and has reversed in the two most deprived deciles, declining by 0.24 years (0.10-0.37) in the most deprived and 0.16 years (0.02-0.29) in the second-most deprived by 2016. Death rates from every disease and at every age were higher in deprived areas than in affluent ones in 2016. The largest contributors to life expectancy inequalities were deaths in children younger than 5 years (mostly neonatal deaths), respiratory diseases, ischaemic heart disease, and lung and digestive cancers in working ages, and dementias in older ages. From 2001 to 2016, the contributions to inequalities declined for deaths in children younger than 5 years, ischaemic heart disease (for both sexes), and stroke and intentional injuries (for men), but increased for most other causes.Interpretation Recent trends in life expectancy in England have not only resulted in widened inequalities but the most deprived communities are now seeing no life expectancy gain. These inequalities are driven by a diverse group of diseases that can be effectively prevented and treated. Adoption of the principle of proportionate universalism to prevention and health and social care can postpone deaths into older ages for all communities and reduce life expectancy inequalities. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.