James Paul D, Wilkins Russell, Detsky Allan S, Tugwell Peter, Manuel Douglas G
Institute for Clinical Evaluative Sciences, G-119, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
J Epidemiol Community Health. 2007 Apr;61(4):287-96. doi: 10.1136/jech.2006.047092.
To examine neighbourhood income differences in deaths amenable to medical care and public health over a 25-year period after the establishment of universal insurance for doctors and hospital services in Canada.
Data for census metropolitan areas were obtained from the Canadian Mortality Database and population censuses for the years 1971, 1986, 1991 and 1996. Deaths amenable to medical care, amenable to public health, from ischaemic heart disease and from other causes were considered. Data on deaths were grouped into neighbourhood income quintiles on the basis of the census tract percentage of population below Canada's low-income cut-offs.
From 1971 to 1996, differences between the richest and poorest quintiles in age-standardised expected years of life lost amenable to medical care decreased 60% (p<0.001) in men and 78% (p<0.001) in women, those amenable to public health increased 0.7% (p = 0.94) in men and 20% (p = 0.55) in women, those lost from ischaemic heart disease decreased 58% in men and 38% in women, and from other causes decreased 15% in men and 9% in women. Changes in the age-standardised expected years of life lost difference for deaths amenable to medical care were significantly larger than those for deaths amenable to public health or other causes for both men and women (p<0.001).
Reductions in rates of deaths amenable to medical care made the largest contribution to narrowing socioeconomic mortality disparities. Continuing disparities in mortality from causes amenable to public health suggest that public health initiatives have a potentially important, but yet un-realized, role in further reducing mortality disparities in Canada.
在加拿大建立医生和医院服务全民保险后的25年期间，研究医疗保健和公共卫生可及性方面的社区收入差异。
从加拿大死亡率数据库以及1971年、1986年、1991年和1996年的人口普查中获取人口普查大都市区的数据。考虑了医疗保健可及性、公共卫生可及性、缺血性心脏病导致的死亡以及其他原因导致的死亡。根据人口普查区低于加拿大低收入临界值的人口百分比，将死亡数据按社区收入五分位数进行分组。
1971年至1996年，在按年龄标准化的因医疗保健可及性导致的预期寿命损失方面，最富有和最贫穷五分位数之间的差异在男性中下降了60%（p<0.001），在女性中下降了78%（p<0.001）；因公共卫生可及性导致的差异在男性中增加了0.7%（p = 0.94），在女性中增加了20%（p = 0.55）；因缺血性心脏病导致的差异在男性中下降了58%，在女性中下降了38%；因其他原因导致的差异在男性中下降了15%，在女性中下降了9%。在按年龄标准化的因医疗保健可及性导致的预期寿命损失差异方面的变化，在男性和女性中均显著大于因公共卫生可及性或其他原因导致的死亡差异（p<0.001）。
医疗保健可及性导致的死亡率下降对缩小社会经济死亡率差距的贡献最大。公共卫生可及性导致的死亡率持续存在差异表明，公共卫生举措在进一步降低加拿大死亡率差距方面具有潜在的重要但尚未实现的作用。
