Lefèvre H, Jougla E, Pavillon G, Le Toullec A
INSERM--CépiDc--IFR 69--Centre d'épidémiologie sur les causes médicales de décès, 44, chemin de Ronde, 78116 Le Vésinet.
Rev Epidemiol Sante Publique. 2004 Sep;52(4):317-28; discussion 329-31. doi: 10.1016/s0398-7620(04)99061-x.
This paper aims to describe and to analyse disparities between men and women for "premature" mortality rates (deaths before 65 year-old). The study is particularly focused on "avoidable" causes of death. These types of deaths are greatly related to risk behaviours such as alcohol abuse, tobacco abuse or dangerous driving. Taking account of these indicators ("premature" and "avoidable" mortality) enables to study health status discrepancies by gender and to characterize specific public health issues in France including high rates of "premature" mortality and risk behaviours.
The analysis is based on exhaustive mortality data from 1980 to 1999 supplied by the Centre for epidemiology of medical causes of death (CepiDc-INSERM). Specific causes of death closely related to risk behaviours are classified as "avoidable": lung and upper airways cancers, cirrhosis, alcoholic psychosis, traffic accidents, aids and suicide. The contribution of these categories in the global male overmortality was assessed according to different demographic and geographic characteristics.
Within "premature" mortality, males experience greater burden of "avoidable" mortality (sex-ratio: 4 versus 2). The gender differences are mainly due to injuries and suicides in the younger age groups and to tobacco and alcohol-related cancers (lung and upper airways) in the 45-64 years age group. The recent decline in "premature" mortality sex-ratio is explained by an increase of these two cancers for females. Among european countries, the French male overmortality is especially marked and mainly attributable to "avoidable" causes of death.
"Avoidable" and "premature" mortality provide useful tools for the follow-up of health status in France particularly because of high risk behaviours and prevention inadequacy. Reducing gender discrepancies will depend mainly on public health policies in terms of primary prevention.
本文旨在描述和分析男性与女性在“过早”死亡率（65岁之前死亡）方面的差异。该研究特别关注“可避免”的死亡原因。这类死亡与酗酒、吸烟或危险驾驶等风险行为密切相关。考虑这些指标（“过早”和“可避免”死亡率）有助于按性别研究健康状况差异，并确定法国特定的公共卫生问题，包括高“过早”死亡率和风险行为。
分析基于由医学死因流行病学中心（法国国家健康与医学研究院CepiDc）提供的1980年至1999年详尽的死亡率数据。与风险行为密切相关的特定死因被归类为“可避免”死因：肺癌和上呼吸道癌、肝硬化、酒精性精神病、交通事故、艾滋病和自杀。根据不同的人口统计学和地理特征评估这些类别在全球男性超额死亡率中的作用。
在“过早”死亡率方面，男性承受着更大的“可避免”死亡率负担（性别比：4比2）。性别差异主要归因于较年轻年龄组的伤害和自杀，以及45 - 64岁年龄组中与烟草和酒精相关的癌症（肺癌和上呼吸道癌）。“过早”死亡率性别比最近的下降是由于女性这两种癌症的增加。在欧洲国家中，法国男性超额死亡率尤为显著，且主要归因于“可避免”的死亡原因。
“可避免”和“过早”死亡率为法国健康状况的跟踪提供了有用工具，特别是鉴于高风险行为和预防不足。减少性别差异将主要取决于一级预防方面的公共卫生政策。
