Smith Michael P, Olatunde Olugbenga, White Chris
Office for National Statistics.
Health Stat Q. 2010 Winter(48):36-57. doi: 10.1057/hsq.2010.20.
The reduction of health inequalities is a long-standing public health priority. Accurate and timely measurement of the magnitude of health inequalities over time is complex, often relying on data available from a decennial census to conduct detailed analyses of social and geographical inequalities. While inequalities in mortality rates and life expectancy are well-established, the scale of inequality in health expectancies has been reported to be even greater. This study examines changes in inequality in disability-free life expectancy (DFLE) over time between Lower Super Output Areas (LSOAs) in England, grouped into quintiles of an area-based measure of relative deprivation.
Life expectancy (LE) and DFLE for males and females at birth and at age 65 were estimated using a combination of survey, mortality and population data; survey data provided an estimate of the prevalence of limiting long-standing illness or disability (LLSI) used in the DFLE metric. An estimate of the inequality in DFLE between area-based quintiles of relative deprivation (using the Index of Multiple Deprivation 2007) in the periods 2001-04 and 2005-08 enabled the measurement of change in equality over time between advantaged and disadvantaged areas.
The prevalence of LLSI among males and females rose incrementally with increasing levels of deprivation in both periods. Males and females in the most deprived areas were more than 1.5 times more likely to report LLSI compared to those in the least deprived areas. There were also large inequalities in LE and DFLE in a similar pattern to LLSI. The extent of inequality in DFLE between the most and least deprived quintiles was approximately twice that of LE. Although LE and DFLE generally increased over time, this improvement varied across quintiles, causing the gap between the most and least deprived quintiles to increase. In comparison with more advantaged areas, people experiencing the greatest deprivation spent the greatest proportion of their lives with a limiting illness or disability, and this proportion increased over time.
Males and females at birth and at age 65 in the less deprived areas could expect longer, healthier lives than their counterparts in more deprived areas in both 2001-04 and 2005-08. This analysis suggests that the inequality in DFLE between deprived and affluent area clusters has increased during the first decade of the 21st century.
减少健康不平等现象是一项长期的公共卫生重点工作。随着时间的推移，准确及时地衡量健康不平等的程度十分复杂，通常要依靠十年一次的人口普查所提供的数据来对社会和地理不平等进行详细分析。虽然死亡率和预期寿命方面的不平等已广为人知，但据报道，健康预期寿命方面的不平等程度甚至更大。本研究考察了英格兰下层超级输出区（LSOA）之间无残疾预期寿命（DFLE）的不平等随时间的变化情况，这些区域按基于地区的相对剥夺衡量指标分为五个等级。
利用调查、死亡率和人口数据相结合的方式，估计出生时和65岁时男性和女性的预期寿命（LE）和无残疾预期寿命；调查数据提供了用于无残疾预期寿命指标的长期限制性疾病或残疾（LLSI）患病率的估计值。对2001 - 04年和2005 - 08年期间基于相对剥夺的地区五分位数（使用2007年多重剥夺指数）之间的无残疾预期寿命不平等进行估计，从而能够衡量优势地区和弱势地区之间平等程度随时间的变化。
在这两个时期，男性和女性中，长期限制性疾病或残疾的患病率随着剥夺程度的增加而逐步上升。与最不贫困地区的男性和女性相比，最贫困地区的男性和女性报告长期限制性疾病或残疾的可能性要高出1.5倍以上。预期寿命和无残疾预期寿命也存在类似长期限制性疾病或残疾的巨大不平等现象。最贫困和最不贫困五分位数之间的无残疾预期寿命不平等程度约为预期寿命不平等程度的两倍。虽然预期寿命和无残疾预期寿命总体上随时间有所增加，但这种改善在各五分位数之间有所不同，导致最贫困和最不贫困五分位数之间的差距扩大。与更具优势的地区相比，贫困程度最高的人群一生中患有限制性疾病或残疾的比例最大，而且这一比例随时间增加。
在2001 - 04年和2005 - 08年期间，出生时和65岁时，贫困程度较低地区的男性和女性比贫困程度较高地区的同龄人预期寿命更长、更健康。该分析表明，在21世纪的第一个十年里，贫困地区和富裕地区集群之间在无残疾预期寿命方面的不平等有所增加。
