Shkolnikov Vladimir M, Andreev Evgueni M, Jasilionis Domantas, Leinsalu Mall, Antonova Olga I, McKee Martin
Max Planck Institute for Demographic Research, Rostock, Germany.
J Epidemiol Community Health. 2006 Oct;60(10):875-81. doi: 10.1136/jech.2005.044719.
The political and social transition in central and eastern Europe has been generally associated with widening educational differences in life expectancy. However, interpretation of these findings is complicated because the size of educational categories within the population has also changed. It is therefore important to disentangle these two phenomena.
The Czech Republic, Estonia, the Russian Federation and, as a western European reference, Finland, in two periods, 1988-89 and 1998-99.
Life tables were calculated in three categories: university; secondary; and less than secondary education. Changes in life expectancy were decomposed into contributions of population composition and within-category mortality.
In Finland and the Czech Republic improvements are seen in all educational groups, with only a slight widening of the educational differences. Over 80% of the total life expectancy increase is attributable to improved mortality within educational categories. In Estonia and Russia, less favourable overall trends coincide with a dramatic widening of the educational gap. A decrease in life expectancy in those with low and middle education has been compensated for, to a small degree in Russia but a greater extent in Estonia, by improvements among those with higher education and by the improved population composition. For highly educated Estonians, the gains were seen at all ages, the greatest at age > or =60 years. In Russia mortality increased in those <60 years although compensated for by improvements at older ages.
Russia and Estonia exhibit much less equitable transitions compared with the Czech Republic. Analyses of trends in health inequalities should capture the changing population composition. In Russia and Estonia an improved educational structure prevented an even greater decline in life expectancy. The highly educated Estonians can potentially catalyse a wider health progress.
中东欧的政治和社会转型通常与预期寿命方面教育差异的扩大有关。然而，由于人口中教育类别规模也发生了变化，这些研究结果的解读变得复杂。因此，厘清这两种现象很重要。
捷克共和国、爱沙尼亚、俄罗斯联邦，以及作为西欧参照的芬兰，分两个时期，即1988 - 1989年和1998 - 1999年。
按大学、中学和低于中学教育三个类别计算生命表。预期寿命的变化被分解为人口构成和类别内死亡率的贡献。
在芬兰和捷克共和国，所有教育群体的预期寿命都有所提高，教育差异仅略有扩大。预期寿命总增长的80%以上归因于教育类别内死亡率的改善。在爱沙尼亚和俄罗斯，总体趋势较不利，同时教育差距急剧扩大。低教育程度和中等教育程度人群预期寿命的下降，在俄罗斯得到了一定程度的补偿，在爱沙尼亚得到了更大程度的补偿，这得益于高等教育人群预期寿命的提高和人口构成的改善。对于受过高等教育的爱沙尼亚人，各年龄段都有预期寿命的增长，60岁及以上人群增长幅度最大。在俄罗斯，60岁以下人群的死亡率上升，不过老年人群死亡率的改善起到了补偿作用。
与捷克共和国相比，俄罗斯和爱沙尼亚的转型公平性要低得多。对健康不平等趋势的分析应考虑不断变化的人口构成。在俄罗斯和爱沙尼亚，教育结构的改善避免了预期寿命出现更大幅度的下降。受过高等教育的爱沙尼亚人有可能推动更广泛的健康进步。
