Trends in health equity in mortality in the United States, 1969-2019.
Trends in health equity in mortality in the United States, 1969-2019.
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DOI：
10.1016/j.ssmph.2021.100966
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Zimmerman FJ
中科院分区：
文献类型：
--
作者：
Anderson NW;Zimmerman FJ
健康公平是公共健康的一个重要问题，然而，随着时间的推移，缺乏对美国健康公平的全面评估。虽然人们可能会假设，随着生活水平的提高，整体健康状况将会改善，但对于健康公平而言，这种假设是没有根据的，因为即使平均健康水平有所改善，健康公平也可能会下降。评估25岁以下、25岁-和65岁及以上人群在国家和州一级卫生公平死亡率方面的趋势。健康公平指标被计算为相对于基准水平的加权平均预期寿命，其定义为最具社会特权的亚群(具有大学或更高教育程度的白人、非拉丁裔男性)的预期寿命。我们分析了国家卫生统计中心从1969年1月1日到2019年12月31日的114,558,346份死亡记录，以评估国家和州一级每年的健康公平。使用ICD-9/ICD-10分类代码，按主要死因分解了健康方面的不平等现象。从1969年到2019年，美国的卫生公平性有所改善(每年+0.36分[95%CI 0.31-0.41])，尽管在过去20年中速度较慢(从2000年到2019年每年+0.08分[95%CI 0.03-0.14]，而1969到2000年每年+0.57分[95%CI 0.50-0.65])。25岁以下人群的健康公平性显著提高(每年+0.82分[95%可信区间0.75-0.89])，而25岁-人群的健康公平性保持不变(−0.01分/年[95%CI-0.03~0.003分])。65岁以上人群的健康公平性呈下降趋势(−0.08分/年[95%CI-0.09分至−0.07分])。意外伤害和杀人案减少带来的权益收益在很大程度上被可归因于药物过量的死亡率上升所抵消。美国未能推进医疗公平，尤其是成年人的健康公平。让政策制定者对健康公平的综合衡量负责，可能有助于协调改善人口健康的努力。我们将一种新的健康公平衡量标准应用于50年来的死亡率数据。25岁以下人群的健康公平性有所增加，而25岁以上人群的健康公平性却有所下降。自2000年以来，卫生公平方面的进展基本上停滞不前。南部和俄亥俄河谷的医疗公平程度最低。某些死因的改善被其他死因的下降所抵消。
Health equity is a significant concern of public health, yet a comprehensive assessment of health equity in the United States over time is lacking. While one might presume that overall health will improve with rising living standards, no such presumption is warranted for health equity, which may decline even as average health improves. To assess trends in national and state-level health equity in mortality for people up to age 25, ages 25–64 and aged 65 and older. A health equity metric was calculated as the weighted mean life expectancy relative to a benchmark level, defined as the life expectancy of the most socially-privileged subpopulation (white, non-Latinx males with a college education or higher). We analyzed 114,558,346 death records from the National Center for Health Statistics, from January 1, 1969 to December 31, 2019 to estimate health equity annually at the national and state-level. Using ICD-9/ICD-10 classification codes, inequities in health were decomposed by major causes of death. From 1969 to 2019, health equity in the United States improved (+0.36 points annually [95% CI 0.31–0.41]), albeit at a slower rate over the last two decades (+0.08 points annually [95% CI 0.03–0.14] from 2000 to 2019, compared to +0.57 points annually from 1969 to 2000 [95% CI 0.50–0.65]). Health equity among those under 25 improved substantially (+0.82 points annually [95% CI 0.75–0.89]) but remained flat for adults 25–64 (−0.01 points annually [95% CI -0.03-0.003]) For those over 65, health equity displayed a downward trend (−0.08 points annually [95% CI -0.09 to −0.07]). Gains in equity from reduced unintentional injuries and homicides have been largely offset by rising mortality attributable to drug overdoses. The US is failing to advance health equity, especially for adults. Keeping policy-makers accountable to a summary measure of health equity may help coordinate efforts at improving population health. We apply a novel measure of health equity to 50 years of mortality data. Health equity has increased for those under 25, yet declined for those 25+. Progress in health equity has largely stalled since 2000. Health equity is lowest in the South and Ohio River Valley. Improvements in certain causes of death have been offset by declines in others.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
影响因子：
12.7
作者：
Moss, NE;Carver, K
通讯作者：
Carver, K
影响因子：
3.5
作者：
Diaz CJ;Koning SM;Martinez-Donate AP
通讯作者：
Martinez-Donate AP
影响因子：
3.5
作者：
Montez, Jennifer Karas;Zajacova, Anna;Beckfield, Jason
通讯作者：
Beckfield, Jason
影响因子：
56.9
作者：
Currie, J.;Schwandt, H.
通讯作者：
Schwandt, H.