Arah Onyebuchi A, Westert Gert P, Delnoij Diana M, Klazinga Niek S
Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
BMC Public Health. 2005 Aug 2;5:81. doi: 10.1186/1471-2458-5-81.
Few studies have tried to assess the combined cross-sectional and temporal contributions of a more comprehensive set of amenable factors to population health outcomes for wealthy countries during the last 30 years of the 20th century. We assessed the overall ecological associations between mortality and factors amenable to public health. These amenable factors included addictive and nutritional lifestyle, air quality, public health spending, healthcare coverage, and immunizations.
We used a pooled cross-sectional, time series analysis with corrected fixed effects regression models in an ecological design involving eighteen member countries of the Organisation for Economic Cooperation and Development during the period 1970 to 1999.
Alcohol, tobacco, and fat consumption, and sometimes, air pollution were significantly associated with higher all-cause mortality and premature death. Immunizations, health care coverage, fruit/vegetable and protein consumption, and collective health expenditure had negative effects on mortality and premature death, even after controlling for the elderly, density of practicing physicians, doctor visits and per capita GDP. However, tobacco, air pollution, and fruit/vegetable intake were sometimes sensitive to adjustments.
Mortality and premature deaths could be improved by focusing on factors that are amenable to public health policies. Tackling these issues should be reflected in the ongoing assessments of health system performance.
在20世纪的最后30年里，很少有研究试图评估一系列更全面的可干预因素对富裕国家人口健康结果的综合横断面和时间贡献。我们评估了死亡率与公共卫生可干预因素之间的总体生态关联。这些可干预因素包括成瘾性和营养性的生活方式、空气质量、公共卫生支出、医疗保健覆盖范围和免疫接种。
我们在一项生态设计中使用了汇总横断面时间序列分析，并采用校正固定效应回归模型，该设计涉及经济合作与发展组织的18个成员国，时间跨度为1970年至1999年。
酒精、烟草和脂肪消费，以及有时的空气污染与全因死亡率和过早死亡显著相关。即使在控制了老年人、执业医生密度、就诊次数和人均国内生产总值之后，免疫接种、医疗保健覆盖范围、水果/蔬菜和蛋白质消费以及集体卫生支出对死亡率和过早死亡仍有负面影响。然而，烟草、空气污染和水果/蔬菜摄入量有时对调整敏感。
关注公共卫生政策可干预的因素能够降低死亡率和过早死亡。解决这些问题应在对卫生系统绩效的持续评估中得到体现。
