Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973-1977 and 1993-1998: increased importance of injury and suicide in inequality for ages under 75
Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973-1977 and 1993-1998: increased importance of injury and suicide in inequality for ages under 75
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DOI：
10.1093/ije/dyh283
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发表时间：
2005-02-01
影响因子：
7.7
通讯作者：
Takano, T
中科院分区：
文献类型：
--
作者：
Fukuda, Y;Nakamura, K;Takano, T
背景健康方面的社会经济不平等一直是公共卫生领域的一个主要问题。本研究使用日本的市町村统计数据，考察了1973-1977年和1993-1998年地区死亡率的社会经济不平等性以及死因对不平等性的影响。（1973-1977年N = 3244人，1993-1998年N = 3334人）按社会经济地位指数（SEP）分为五个等级通过与收入和教育有关的市政指标的主成分分析获得。使用五分位数标准化死亡率和五分位数间死亡率比，对0-74岁人口中选定主要死亡原因的SEP死亡率梯度进行了检查。作为一个措施的具体原因对不平等的影响，从每一个原因在较低的四个SEP五分位数与最高的五分位数相比，超额死亡人数calculated.Results死亡率梯度SEP和超额死亡在较低的SEP五分位数由于受伤和自杀显着增加，从1973-1977年至1993-1998年的男性和女性。相比之下，中风，特别是脑出血，死亡率梯度下降，超额死亡。在1993-1998年，女性的SEP死亡率的负梯度被发现，和癌症贡献了较高的全因死亡率在较高的SEP quintile.Conclusions社会经济不平等的相对重要性，脑卒中的区域死亡率下降，而伤害和自杀的增加。应优先考虑在社会经济条件差的地区预防伤害和自杀以及中风，在SEP较高的城市地区预防癌症。
Background Socioeconomic inequality in health has been a major concern in public health. This study examined socioeconomic inequality in regional mortality and the impact on inequality by cause of deaths in 1973-1977 and 1993-1998 using municipal statistics in Japan.Methods The municipalities across the country (N = 3244 in 1973-1977 and 3334 in 1993-1998) were classified into quintiles according to the index of socioeconomic position (SEP) obtained by principal component analysis of municipal indicators related to income and education. Mortality gradient by SEP for selected major causes of death in the population aged 0-74 years was examined using standardized mortality ratio by quintile and rate ratio of mortality across quintiles. As a measure of cause-specific impact on inequality, the number of excess deaths from each cause in the lower four SEP quintiles compared with the highest quintile was calculated.Results Mortality gradient by SEP and excess deaths in the lower SEP quintiles due to injury and suicide markedly increased from 1973-1977 to 1993-1998 for both males and females. In contrast, stroke, especially cerebral haemorrhage, showed a decrease in mortality gradient and excess deaths. For females in 1993-1998, a negative gradient of mortality by SEP was found, and cancer contributed the higher all-cause mortality in the higher SEP quintile.Conclusions The relative importance of socioeconomic inequality in regional mortality of stroke decreased, while that of injury and suicide increased. The prevention of injury and suicide, in addition to stroke, in socioeconomically disadvantaged regions, and cancer in urban areas with higher SEP should be given priority.