Ali Mohammad, Jin Yang, Kim Deok Ryun, De Zhou Bao, Park Jin Kyung, Ochiai Rion Leon, Dong Baiqing, Clemens John D, Acosta Camilo J
International Vaccine Institute, Seoul, Korea.
Int J Health Geogr. 2007 Jul 24;6:31. doi: 10.1186/1476-072X-6-31.
Although economic reforms have brought significant benefits, including improved health care to many Chinese people, accessibility to improved care has not been distributed evenly throughout Chinese society. Also, the effects of the uneven distribution of improved healthcare are not clearly understood. Evidence suggests that mortality is an indicator for evaluating accessibility to improved health care services. We constructed spatially smoothed risk maps for gender-specific adult mortality in an area of southern China comprising both urban and rural areas and identified ecological factors of gender-specific mortality across societies.
The study analyzed the data of the Hechi Prefecture in southern in China. An average of 124,204 people lived in the area during the study period (2002-2004). Individual level data for 2002-2004 were grouped using identical rectangular cells (regular lattice) of 0.25 km2. Poisson regression was fitted to the group level data to identify gender-specific ecological factors of adult (ages 15-<45 years) mortality. Adult male mortality was more than two-fold higher than adult female mortality. Adults were likely to die of injury, poisoning, or trauma. Significantly more deaths were observed in poor areas than in areas with higher incomes. Specifically, higher spatial risk for adult male mortality was clustered in two rural study areas, which did not overlap with neighborhoods with higher risk for adult female mortality. One high-risk neighborhood for adult female mortality was in a poor urban area.
We found a disparity in mortality rates between rural and urban areas in the study area in southern China, especially for adult men. There were also differences in mortality rates between poorer and wealthy populations in both rural and urban areas, which may in part reflect differences in health care quality. Spatial influences upon adult male versus adult female mortality difference underscore the need for more research on gender-related influences on adult mortality in China.
尽管经济改革带来了显著益处，包括为许多中国人改善了医疗保健，但改善后的医疗服务可及性在中国社会并未得到均衡分配。此外，改善后的医疗保健不均衡分配所产生的影响尚未得到明确认识。有证据表明，死亡率是评估改善后的医疗服务可及性的一个指标。我们构建了中国南方一个包括城乡地区在内的区域特定性别的成人死亡率空间平滑风险图，并确定了不同社会中特定性别的死亡率的生态因素。
该研究分析了中国南方河池地区的数据。在研究期间（2002 - 2004年），该地区平均有124,204人居住。2002 - 2004年的个体层面数据使用面积为0.25平方公里的相同矩形单元格（规则网格）进行分组。对分组层面的数据进行泊松回归，以确定成人（15 - <45岁）死亡率的特定性别生态因素。成年男性死亡率比成年女性死亡率高出两倍多。成年人可能死于伤害、中毒或创伤。贫困地区的死亡人数明显多于高收入地区。具体而言，成年男性死亡率较高的空间风险集中在两个农村研究区域，与成年女性死亡率较高的社区并不重叠。成年女性死亡率的一个高风险社区位于贫困的城市地区。
我们发现中国南方研究区域的城乡死亡率存在差异，尤其是成年男性。城乡贫困和富裕人群之间的死亡率也存在差异，这可能部分反映了医疗保健质量的差异。成年男性与成年女性死亡率差异的空间影响凸显了在中国对与性别相关的成年死亡率影响进行更多研究的必要性。
