Wamala Sarah, Blakely Tony, Atkinson June
Swedish National Institute of Public Health and Karolinska Institutet, Sweden.
BMC Public Health. 2006 Jun 21;6:164. doi: 10.1186/1471-2458-6-164.
Both trends in socioeconomic inequalities in mortality, and cross-country comparisons, may give more information about the causes of health inequalities. We analysed trends in socioeconomic differentials by mortality from early 1980s to late 1990s, comparing Sweden with New Zealand.
The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3-5 year follow-up and limited to individuals aged 25-77 years. Age standardised mortality rates were calculated using the European population standard.
Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden. Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand (p for trend <0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden (p = 0.03) and by 8% in New Zealand (p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden (p for trend = 0.06), but increased by 16% in New Zealand (p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden (p = 0.03) and 21% in New Zealand (p = 0.04).
Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.
死亡率方面社会经济不平等的趋势以及跨国比较，可能会提供更多关于健康不平等原因的信息。我们分析了20世纪80年代初至90年代末按死亡率划分的社会经济差异趋势，并将瑞典与新西兰进行了比较。
分析使用了由200多万人组成的新西兰人口普查死亡率研究（NZCMS）以及由10多万人组成的瑞典生活条件调查（ULF）。教育程度和家庭收入被用作社会经济地位（SEP）的衡量指标。计算不平等斜率指数（SII）以估计死亡率的绝对不平等。分析基于3至5年的随访，且仅限于25至77岁的个体。使用欧洲人口标准计算年龄标准化死亡率。
20世纪80年代和90年代，瑞典和新西兰按教育程度划分的男性和女性死亡率绝对不平等程度平均相似，但按收入划分的话，瑞典的更大。比较20世纪80年代和90年代绝对不平等的趋势，瑞典男性按教育程度划分的绝对不平等下降了66%，新西兰下降了17%（两国趋势p值均<0.01）。瑞典女性按教育程度划分的绝对不平等下降了19%（p = 0.03），新西兰下降了8%（p = 0.53）。瑞典男性按收入划分的绝对不平等下降了51%（趋势p值 = 0.06），但新西兰上升了16%（p = 0.13）。两国女性按收入划分的绝对不平等均有所上升：瑞典上升了12%（p = 0.03），新西兰上升了21%（p = 0.04）。
死亡率方面社会经济不平等的趋势显然对瑞典男性最为有利。在新西兰，这种趋势似乎对男性也比对女性更有利。假设瑞典男性不平等的趋势不是统计上的偶然发现，那么尚不清楚明显下降的实质性原因是什么。需要进一步进行性别比较。
