Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
Am J Public Health. 2011 Aug;101(8):1456-65. doi: 10.2105/AJPH.2010.300086. Epub 2011 Jun 16.
We estimated the number of deaths attributable to social factors in the United States.
We conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. We calculated summary relative risk estimates of mortality, and we obtained and used prevalence estimates for each social factor to calculate the population-attributable fraction for each factor. We then calculated the number of deaths attributable to each social factor in the United States in 2000.
Approximately 245,000 deaths in the United States in 2000 were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty.
The estimated number of deaths attributable to social factors in the United States is comparable to the number attributed to pathophysiological and behavioral causes. These findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.
我们估计了美国社会因素导致的死亡人数。
我们对 1980 年至 2007 年间发表的所有英文文章进行了 MEDLINE 检索，这些文章估计了社会因素与成人全因死亡率之间的关系。我们计算了死亡率的综合相对风险估计值，并获得并使用了每种社会因素的流行率估计值，以计算每种因素的人群归因分数。然后，我们计算了 2000 年美国每种社会因素导致的死亡人数。
2000 年美国约有 24.5 万人的死亡归因于受教育程度低，17.6 万人归因于种族隔离，16.2 万人归因于社会支持低，13.3 万人归因于个人层面的贫困，11.9 万人归因于收入不平等，3.9 万人归因于地区层面的贫困。
美国社会因素导致的死亡人数估计数与归因于病理生理和行为原因的死亡人数相当。这些发现表明，需要更广泛的公共卫生概念来理解死亡率的原因，并采取广泛的政策方法来考虑如何解决社会因素，以改善人群的健康。
