Moniruzzaman Syed, Andersson Ragnar
Division of Public Health Sciences, Department of Health and Environmental Sciences, Karlstad University, 651 88 Karlstad, Sweden.
Soc Sci Med. 2008 Apr;66(8):1699-708. doi: 10.1016/j.socscimed.2007.12.020. Epub 2008 Mar 4.
Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960-1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of USD 3,000-USD 4,000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around USD 13,000-USD 14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.
横断面研究已得出伤害死亡率与经济发展之间清晰的倒U形曲线；然而，这并不意味着单个国家随着时间推移变得更加富裕时一定会遵循类似的曲线。本研究旨在探讨能否用纵向研究方法验证先前横断面研究的结果。伤害死亡率和人均国内生产总值（GDP）的数据均取自经济合作与发展组织（OECD）成员国1960 - 1999年的官方卫生数据库。然后使用回归模型来检验这两个变量之间的纵向关系。在所选定国家的所有收入类别中，伤害死亡率都有显著改善。对于高收入和中高收入国家，伤害死亡率（所有原因）在1972年之前上升，于1972年达到峰值，随后下降。对于GDP相对较低的工业化国家，伤害死亡率在1977年之前上升，之后下降。使用伤害死亡率的三次回归线，对于所有收入类别，伤害死亡率在人均GDP达到3000 - 4000美元之前上升，之后显著下降。在所有收入类别中，直到国家人均GDP达到约13000 - 14000美元时，自杀率和凶杀率才呈现上升趋势。值得注意的是，与故意伤害类别相比，道路交通事故和跌倒伤害导致的死亡率在经济发展过程中下降得更早。高收入国家之间的纵向分析证实了先前横断面研究的结果；也就是说，大多数伤害类别似乎都遵循倒U形趋势线，在时间和经济发展的各个阶段达到峰值后呈下降趋势。时间与经济之间的比较表明，同一伤害类别在不同国家达到峰值的时间差异部分反映了经济发展的时间差异。
