Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance
Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance
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DOI：
10.1136/jech.2006.047092
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发表时间：
2007-04-01
影响因子：
6.3
通讯作者：
Manuel, Douglas G.
中科院分区：
文献类型：
--
作者：
James, Paul D.;Wilkins, Russell;Manuel, Douglas G.
目的：研究邻里收入差异的死亡，适合医疗保健和公共卫生超过25年的时间后，建立普遍保险的医生和医院servicesin Canada.Methods：数据普查大都市地区获得加拿大死亡率数据库和人口普查的年份1971年，1986年，1991年和1996年。考虑了可接受医疗护理、可接受公共卫生、缺血性心脏病和其他原因造成的死亡。根据人口普查区低于加拿大低收入分界线的人口百分比，将死亡数据按社区收入五分位数分组。从1971年到1996年，最富有和最贫穷的五分之一人口在年龄标准化预期寿命损失方面的差异减少了60%（p < 0.001）男性和78%（p < 0.001）在妇女中，那些适合公共卫生的人增加了0.7%（p = 0.94）男性和20%（p = 0.55）在女性中，因缺血性心脏病而死亡的人数男性减少了58%，女性减少了38%，其他原因造成的死亡率男性下降15%，女性下降9%。年龄标准化的预期寿命损失年数的变化差异，适合医疗保健的死亡显着大于那些适合公共卫生或其他原因的死亡，男性和女性（p < 0.001）。结论：减少适合医疗保健的死亡率作出了最大的贡献，缩小社会经济死亡率的差距。在死亡率的原因服从公共卫生的持续差异表明，公共卫生举措有一个潜在的重要，但尚未实现，在进一步减少加拿大的死亡率差距的作用。
Aim: To examine neighbourhood income differences in deaths amenable to medical care and public health over a 25-year period after the establishment of universal insurance for doctors and hospital services in Canada.Methods: Data for census metropolitan areas were obtained from the Canadian Mortality Database and population censuses for the years 1971, 1986, 1991 and 1996. Deaths amenable to medical care, amenable to public health, from ischaemic heart disease and from other causes were considered. Data on deaths were grouped into neighbourhood income quintiles on the basis of the census tract percentage of population below Canada's low-income cut-offs.Results: From 1971 to 1996, differences between the richest and poorest quintiles in age-standardised expected years of life lost amenable to medical care decreased 60% (p < 0.001) in men and 78% (p < 0.001) in women, those amenable to public health increased 0.7% (p = 0.94) in men and 20% (p = 0.55) in women, those lost from ischaemic heart disease decreased 58% in men and 38% in women, and from other causes decreased 15% in men and 9% in women. Changes in the age-standardised expected years of life lost difference for deaths amenable to medical care were significantly larger than those for deaths amenable to public health or other causes for both men and women (p < 0.001).Conclusions: Reductions in rates of deaths amenable to medical care made the largest contribution to narrowing socioeconomic mortality disparities. Continuing disparities in mortality from causes amenable to public health suggest that public health initiatives have a potentially important, but yet unrealised, role in further reducing mortality disparities in Canada.