Lorant V
Socio-économie de la santé, Ecole de Santé Publique, Université Catholique de Louvain, Clos chapelle aux champs 30.41, 1200 Bruxelles, Belgique.
Rev Epidemiol Sante Publique. 2000 Jun;48(3):239-47.
The reduction of socio-economic inequality in mortality is an important public health goal. Previous ecological studies aimed at studying the relationship between mortality rate and socio-economic factors have paid little attention to mortality causes avoidable by primary or secondary prevention. Furthermore, these studies do not make the distinction between, on the one hand, the strength of the relationship mortality/socio-economic deprivation and, on the other hand, the significance of the unequal distribution of mortality. The present work is aimed at measuring the strength of this relationship and the concentration of mortality in relation to socio-economic deprivation for both overall mortality and mortality avoidable by primary and secondary prevention.
Standardised mortality ratios were computed at the community level in Belgium (1985-93 period) for all causes and for 11 mortality causes avoidable by primary and secondary prevention. A deprivation index was elaborated using a factorial principal component analysis on 11 socio-economic indicators. The mortality/deprivation relationship was assessed by way of a standardised regression coefficient (B) while socio-economic concentration of mortality was estimated using the Concentration Illness Index (Cii) and the P90/P10 ratio.
A strong positive relationship was found between mortality and deprivation for under 65 years all-causes mortality (B =0.71; CI [0.66; 0.76]), mortality for cirrhosis of the liver (B =0.56; CI [0.51; 0.62]), lung cancer (B =0.49; CI [0.42; 0. 56]), suicide (B =0.35; CI [0.29; 0.42]) and falls (B =0.34; CI [0. 28; 0.41]). However, the concentration of mortality was more limited: 14% (CI [11%-17%]) of cirrhosis of the liver mortality, 7% of fall (CI [5%-10%]) and suicide mortality (CI [4%-9%]), 6% (CI [5%-7%]) of lung cancer mortality is unequally distributed.
Socio-economic deprivation is positively associated with mortality. This association is more pronounced for tobacco, alcohol and mental health related mortality. However, the strength of the relationship between socio-economic deprivation and mortality is not a good indicator of unequal distribution.
降低死亡率方面的社会经济不平等是一项重要的公共卫生目标。以往旨在研究死亡率与社会经济因素之间关系的生态学研究很少关注可通过一级或二级预防避免的死亡原因。此外，这些研究没有区分一方面死亡率与社会经济剥夺之间关系的强度，另一方面死亡率不平等分布的显著性。本研究旨在衡量这种关系的强度以及总体死亡率和可通过一级和二级预防避免的死亡率相对于社会经济剥夺的集中程度。
在比利时社区层面（1985 - 93年期间）计算所有原因以及11种可通过一级和二级预防避免的死亡原因的标准化死亡率。使用对11个社会经济指标的因子主成分分析制定了一个剥夺指数。通过标准化回归系数（B）评估死亡率与剥夺之间的关系，同时使用集中疾病指数（Cii）和P90/P10比率估计死亡率的社会经济集中程度。
发现65岁以下全因死亡率（B = 0.71；CI [0.66；0.76]）、肝硬化死亡率（B = 0.56；CI [0.51；0.62]）、肺癌死亡率（B = 0.49；CI [0.42；0.56]）、自杀死亡率（B = 0.35；CI [0.29；0.42]）和跌倒死亡率（B = 0.34；CI [0.28；0.41]）与剥夺之间存在强烈的正相关关系。然而，死亡率的集中程度较为有限：肝硬化死亡率的14%（CI [11% - 17%]）、跌倒死亡率的7%（CI [5% - 10%]）和自杀死亡率的7%（CI [4% - 9%]）、肺癌死亡率的6%（CI [5% - 7%]）分布不均。
社会经济剥夺与死亡率呈正相关。这种关联在与烟草、酒精和心理健康相关的死亡率方面更为明显。然而，社会经济剥夺与死亡率之间关系的强度并不是不平等分布的良好指标。
