Widening socioeconomic disparities in US childhood mortality, 1969-2000
Widening socioeconomic disparities in US childhood mortality, 1969-2000
复制标题
DOI：
10.2105/ajph.2006.087320
复制
发表时间：
2007-09-01
影响因子：
12.7
通讯作者：
Kogan, Michael D.
中科院分区：
文献类型：
--
作者：
Singh, Gopal K.;Kogan, Michael D.
目标。我们调查了1969至2000年间美国1-14岁儿童总体和特定原因死亡率的地区社会经济不平等的变化程度。我们将基于人口普查的贫困指数与1969年至2000年的美国县死亡率数据联系起来。我们使用泊松和对数线性回归和不平等指数来分析时间差异。尽管儿童死亡率显著下降，但在研究期间，总体儿童死亡率的社会经济梯度(相对死亡风险)大幅增加。在1969-1971年间，最贫困的社会经济五分之一的儿童比最贫穷的社会经济五分之一的儿童患各种原因、出生缺陷、意外伤害和凶杀死亡的风险分别高出52%、13%、69%和76%。相应的相对危险度从1998~2000年分别增加到86%、44%、177%、159%。所有社会经济五分位数儿童死亡率的大幅下降是公共卫生的一大成功。然而，社会经济五分位数较高的儿童在总体、伤害和自然原因死亡率方面的降幅比社会经济五分位数较少的儿童要大得多，这也是造成社会经济死亡率差距扩大的原因之一。儿童死亡率差距的扩大可能反映了物质和社会条件上的贫困五分位数之间日益严重的两极分化。
Objectives. We examined the extent to which area socioeconomic inequalities in overall and cause-specific mortality among US children aged 1-14 years changed between 1969 and 2000.Methods. We linked a census-based deprivation index to US county mortality data from 1969 to 2000. We used Poisson and log-linear regression and inequality indices to analyze temporal disparities.Results. Despite marked declines in child mortality, socioeconomic gradients (relative mortality risks) in overall child mortality increased substantially during the study period. During 1969-1971, children in the most deprived socioeconomic quintile had 52%, 13%, 69%, and 76% higher risks of all-cause, birth defect, unintentional injury, and homicide mortality, respectively, than did children in the least deprived socioeconomic quintile. The corresponding relative risks increased to 86%, 44%, 177%, 159%, respectively from 1998-2000.Conclusions. Dramatic reductions in mortality among children in all socioeconomic quintiles represent a major public health success. However, children in higher socioeconomic quintiles experienced much larger declines in overall, injury, and natural-cause mortality than did those in more deprived socioeconomic quintiles, which contributed to the widening socioeconomic gap in mortality. Widening disparities in child mortality may reflect increasing polarization among deprivation quintiles in material and social conditions.