Investigating the impact of the English health inequalities strategy: time trend analysis.
Investigating the impact of the English health inequalities strategy: time trend analysis.
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DOI：
10.1136/bmj.j3310
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发表时间：
2017-07-26
期刊：
影响因子：
--
通讯作者：
Whitehead M
中科院分区：
文献类型：
--
作者：
Barr B;Higgerson J;Whitehead M
目的探讨英国健康不平等战略是否与地理健康不平等的下降有关，与战略前后的趋势相比。 设计时间趋势分析。 设置两组较低层的地方当局在英格兰。最贫穷的，最底层的五分之一和英格兰的其他人。 干预英国健康不平等战略-1997年至2010年期间实施的跨政府战略，以减少英格兰的健康不平等。使用分段线性回归评估了该战略之前（1983-2003年）、期间（2004- 2012年）和之后（2013- 2015年）的地理健康不平等趋势。 主要结果测量地理健康不平等测量的相对和绝对差异，男性和女性的出生时预期寿命之间的最贫困的地方当局在英格兰和该国其他地区。 结果在实施该战略之前，英格兰最贫困地方当局与全国其他地区之间的男女预期寿命差距差距以每年0.57个月（95%置信区间0.40至0.74个月）和每年0.30个月（0.12至0.48个月）的速度增加。在该战略期间，这一趋势发生了逆转，男子预期寿命的差距每年减少0.91个月（从0.54个月减少到1.27个月），妇女每年减少0.50个月（从0.15个月减少到0.86个月）。自战略期结束以来，不平等差距再次以每年0.68个月（-0.20至1.56个月）的速度扩大，男性每年0.31个月（-0.26至0.88个月）。到2012年，如果该战略之前的不平等趋势继续下去，男性预期寿命的差距将缩小1.2岁（95%置信区间缩小0.8至1.5岁），女性预期寿命的差距将缩小0.6岁（缩小0.3至1.0岁）。 结论英国的健康不平等战略与预期寿命的地理不平等下降，扭转了以前的增长趋势。自该战略结束以来，不平等现象又开始加剧。该战略可能减少了预期寿命方面的地域保健不平等，今后的做法应借鉴这一经验。令人关切的是，目前的政策正在逆转该战略的成就。
Objective To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy. Design Time trend analysis. Setting Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England. Intervention The English health inequalities strategy—a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression. Main outcome measure Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country. Results Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (−0.20 to 1.56 months) for men and 0.31 months each year (−0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued. Conclusion The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy.
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影响因子：
6.3
作者：
Barr B;Taylor-Robinson D;Stuckler D;Loopstra R;Reeves A;Whitehead M
通讯作者：
Whitehead M
影响因子：
6.3
作者：
Asaria, Miqdad;Ali, Shehzad;Cookson, Richard
通讯作者：
Cookson, Richard
影响因子：
4.4
作者：
Dixon, Anna;Khachatryan, Artak;Gilmour, Stuart
通讯作者：
Gilmour, Stuart
影响因子：
17.3
作者：
Hiam, Lucinda;Dorling, Danny;McKee, Martin
通讯作者：
McKee, Martin
在大衰退之前和期间，整体和社会经济地位的健康和健康行为使用西班牙重复的横断面健康调查的数据（2001- 2012年）。
影响因子：
4.5
作者：
Bartoll X;Toffolutti V;Malmusi D;Palència L;Borrell C;Suhrcke M
通讯作者：
Suhrcke M