Elstad Jon Ivar, Dahl Espen, Hofoss Dag
NOVA-Norsk institutt for forskning om oppvekst, velferd og aldring, Postboks 3223 Elisenberg, 0208 Oslo.
Tidsskr Nor Laegeforen. 2005 Nov 17;125(22):3082-4.
A prominent theme in current health research is whether large income inequality in a society in itself has negative consequences for population health, in addition to the effects of individual risk factors. The present study investigates whether mortality in Norway during the 1990s was higher in geographical regions with particularly skewed income distributions.
Register data for all inhabitants aged 25-66 in Norway in 1992 were used (N = approx. 2.2 millions), including information about deaths 1993-99. Norwegian municipalities were grouped into 23 regions. Gini coefficients indicating the degree of inequality in the income distribution were calculated for each region. Deaths 1993-99 were analysed by means of multiple logistic regression.
Odds ratios for deaths 1993-99 were strongly influenced by well-known individual risk factors such as sex, age, marital status, educational level, personal income, and disability. In addition, odds ratios for death were significantly associated with the regions' gini coefficients when adjustments were made for average income level in the regions. This effect of income inequality was pronounced for people with low education, but almost absent among those with higher education. Moreover, the income inequality effect was to some extent driven by special circumstances in Oslo, Norway's capital city, with its high mortality among the less educated and a particularly non-egalitarian income distribution. However, the pattern of higher mortality associated with higher levels of income inequality among the less educated was also observed in the 22 regions outside Oslo.
We found a discernible, although not very strong, association between regional income inequality and mortality levels among the less educated. Several interpretations for this statistical tendency could be proposed; the social processes generating this tendency should be clarified further.
当前健康研究中的一个突出主题是，除了个体风险因素的影响之外，社会中巨大的收入不平等本身是否会对人群健康产生负面影响。本研究调查了20世纪90年代挪威收入分布特别不均衡的地理区域的死亡率是否更高。
使用了1992年挪威所有25至66岁居民的登记数据（N = 约220万），包括1993 - 1999年的死亡信息。挪威的市镇被划分为23个区域。计算了每个区域表明收入分配不平等程度的基尼系数。通过多元逻辑回归分析了1993 - 1999年的死亡情况。
1993 - 1999年死亡的比值比受性别、年龄、婚姻状况、教育水平、个人收入和残疾等众所周知的个体风险因素的强烈影响。此外，在对各区域的平均收入水平进行调整后，死亡的比值比与各区域的基尼系数显著相关。收入不平等的这种影响在低教育程度人群中较为明显，但在高教育程度人群中几乎不存在。此外，收入不平等效应在一定程度上是由挪威首都奥斯陆的特殊情况所驱动的，奥斯陆在受教育程度较低人群中死亡率较高，且收入分配特别不平等。然而，在奥斯陆以外的22个区域也观察到了低教育程度人群中收入不平等程度越高死亡率越高的模式。
我们发现区域收入不平等与低教育程度人群的死亡率水平之间存在一种可察觉的、尽管不是很强的关联。对于这种统计趋势可以提出几种解释；产生这种趋势的社会过程应进一步阐明。
