North-South disparities in English mortality 1965-2015: longitudinal population study
North-South disparities in English mortality 1965-2015: longitudinal population study
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DOI：
10.1136/jech-2017-209195
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发表时间：
2017-09-01
影响因子：
6.3
通讯作者：
Doran, Tim
中科院分区：
文献类型：
--
作者：
Buchan, Iain E.;Kontopantelis, Evangelos;Doran, Tim
背景英格兰北部和南部之间的社会、经济和健康差距一直存在，尽管政府制定了缩小差距的政策。我们研究了英格兰北部和南部不同年龄段的过早死亡率的长期趋势，以及在1965年大衰退后死亡率模式是否发生了变化。方法全人口范围的纵向研究(20082009-2015年)英格兰最北端的五个地区与最南端的四个地区的死亡率--总人口的一半。主要观察指标：直接按年龄性别调整的死亡率；北方超额死亡率(北方超额死亡率与南方超额死亡率的百分比，年龄性别调整后)。结果从1965年到2010年，过早死亡率(每万名75岁老人的死亡人数)从下降到南部的28人，而英格兰北部为72人到35人。从2010年到2015年，英格兰北部和南部过早死亡率的下降速度停滞不前。对于大多数年龄段来说，从1965年到2015年，北方的超额死亡率保持不变。然而，在25-34岁和35-44岁年龄组中，北方超额死亡率在1995至2015年间急剧上升：分别从2.2%(95%CI-3.2%至7.6%)至29.3%(95%CI 21.0%至37.6%)；3.3%(95%CI-1.0%至7.6%)至49.4%(95%CI 42.8%至55.9%)。这是因为自20世纪90年代中期以来，英格兰北部的死亡率上升(25-34岁)或持平(35-44岁)，而南部的死亡率主要下降。结论过去50年来，英格兰北部的超额死亡率在25岁和45岁以上的人群中一直是一致的，但自90年代中期以来，25-44岁人群的超额死亡率上升得令人担忧，远远早于大衰退。这种严重和日益恶化的结构性不平等需要更公平的经济、社会和卫生政策，包括对全英格兰过早死亡率下降的潜在反应。
Background Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 20082009 Great Recession.Methods Population-wide longitudinal (1965-2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions - halves of overall population. Main outcome measure: directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted).Results From 1965 to 2010, premature mortality (deaths per 10 000 aged < 75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25-34 and 35-44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI -3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI - 1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25-34) or plateauing (ages 35-44) from the mid-1990s while southern mortality mainly declined.Conclusions England's northern excess mortality has been consistent among those aged < 25 and 45+ for the past five decades but risen alarmingly among those aged 25-44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.