School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia.
BMC Public Health. 2012 Jan 25;12:79. doi: 10.1186/1471-2458-12-79.
Australian mortality rates are higher in regional and remote areas than in major cities. The degree to which this is driven by variation in modifiable risk factors is unknown.
We applied a risk prediction equation incorporating smoking, cholesterol and blood pressure to a national, population based survey to project all-causes mortality risk by geographic region. We then modelled life expectancies at different levels of mortality risk by geographic region using a risk percentiles model. Finally we set high values of each risk factor to a target level and modelled the subsequent shift in the population to lower levels of mortality risk and longer life expectancy.
Survival is poorer in both Inner Regional and Outer Regional/Remote areas compared to Major Cities for men and women at both high and low levels of predicted mortality risk. For men smoking, high cholesterol and high systolic blood pressure were each associated with the mortality difference between Major Cities and Outer Regional/Remote areas--accounting for 21.4%, 20.3% and 7.7% of the difference respectively. For women smoking and high cholesterol accounted for 29.4% and 24.0% of the difference respectively but high blood pressure did not contribute to the observed mortality differences. The three risk factors taken together accounted for 45.4% (men) and 35.6% (women) of the mortality difference. The contribution of risk factors to the corresponding differences for inner regional areas was smaller, with only high cholesterol and smoking contributing to the difference in men-- accounting for 8.8% and 6.3% respectively-- and only smoking contributing to the difference in women--accounting for 12.3%.
These results suggest that health intervention programs aimed at smoking, blood pressure and total cholesterol could have a substantial impact on mortality inequities for Outer Regional/Remote areas.
澳大利亚的死亡率在地区和偏远地区比在主要城市更高。这种情况在多大程度上是由可改变的危险因素的差异驱动的尚不清楚。
我们应用了一个包含吸烟、胆固醇和血压的风险预测方程，对一项全国性的基于人群的调查进行了分析，以预测地理区域的全因死亡率风险。然后，我们使用风险百分位数模型，根据地理区域的不同死亡率风险水平来预测预期寿命。最后，我们将每个风险因素的高值设定为一个目标水平，并模拟随后人口向更低死亡率风险和更长预期寿命的转移。
无论预测死亡率风险水平高低，男性和女性在内陆地区和边远地区的生存状况都比在主要城市差。对于男性，吸烟、高胆固醇和高血压收缩压都与主要城市和边远地区之间的死亡率差异有关，分别占差异的 21.4%、20.3%和 7.7%。对于女性，吸烟和高胆固醇分别占差异的 29.4%和 24.0%，但高血压收缩压对观察到的死亡率差异没有贡献。这三个危险因素共同解释了 45.4%（男性）和 35.6%（女性）的死亡率差异。对于内陆地区，危险因素对相应差异的贡献较小，只有高胆固醇和吸烟对男性差异有贡献，分别占 8.8%和 6.3%，只有吸烟对女性差异有贡献，占 12.3%。
这些结果表明，针对吸烟、血压和总胆固醇的健康干预计划可能对边远地区的死亡率不公平问题产生重大影响。
