日本成年人过早死亡中的社会和地理不平等：一项1970年至2005年的多层次观察性研究。
Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005.
作者信息
Suzuki Etsuji, Kashima Saori, Kawachi Ichiro, Subramanian S V
机构信息
Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
出版信息
BMJ Open. 2012 Mar 2;2(2):e000425. doi: 10.1136/bmjopen-2011-000425. Print 2012.
OBJECTIVES
To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.
DESIGN
Observational study of the vital statistics and the census data.
SETTING
Japan.
PARTICIPANTS
Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984 022 and 532 223 in men and women, respectively.
MAIN OUTCOME MEASURES
For each sex, ORs and 95% CIs for mortality were estimated by using multilevel logistic regression models with 'cells' (cross-tabulated by age and occupation) at level 1, 8 years at level 2 and 47 prefectures at level 3. The prefecture-level variance was used as an estimate of geographic inequalities of mortality.
RESULTS
Adjusting for age and time-trends, compared with production process and related workers, ORs ranged from 0.97 (95% CI 0.96 to 0.98) among administrative and managerial workers to 2.22 (95% CI 2.19 to 2.24) among service workers in men. By contrast, in women, the lowest odds for mortality was observed among production process and related workers (reference), while the highest OR was 12.22 (95% CI 11.40 to 13.10) among security workers. The degree of occupational inequality increased in both sexes. Higher occupational groups did not experience reductions in mortality throughout the period and was overtaken by lower occupational groups in the early 1990s, among men. Conditional on individual age and occupation, overall geographic inequalities of mortality were relatively small in both sexes; the ORs ranged from 0.87 (Okinawa) to 1.13 (Aomori) for men and from 0.84 (Kanagawa) to 1.11 (Kagoshima) for women, even though there is a suggestion of increasing inequalities across prefectures since 1995 in both sexes.
CONCLUSIONS
The present findings suggest that both social and geographic inequalities in all-cause mortality have increased in Japan during the last 3 decades.
目的
研究日本全因过早成人死亡率的社会和地理不平等趋势。
设计
对生命统计数据和人口普查数据的观察性研究。
地点
日本。
参与者
1970年、1975年、1980年、1985年、1990年、1995年、2000年和2005年年龄在25岁及以上且小于65岁的全体人口。男性死亡总数为984022人，女性为532223人。
主要观察指标
对于每种性别，通过使用多级逻辑回归模型估计死亡率的比值比（OR）和95%置信区间（CI），模型中一级为“单元格”（按年龄和职业交叉分类），二级为8年，三级为47个都道府县。都道府县水平的方差用作死亡率地理不平等的估计值。
结果
在调整年龄和时间趋势后，与生产过程及相关工人相比，男性中行政和管理人员的OR为0.97（95%CI 0.96至0.98），服务工人的OR为2.22（95%CI 2.19至2.24）。相比之下，女性中生产过程及相关工人的死亡率比值最低（作为参照），而保安人员的最高OR为12.22（95%CI 11.40至13.10）。两性的职业不平等程度均有所增加。在整个时期内，较高职业群体的死亡率并未下降，在20世纪90年代初，男性中较低职业群体的死亡率超过了较高职业群体。在个体年龄和职业条件下，两性总体死亡率的地理不平等相对较小；男性的OR范围从0.87（冲绳县）到1.13（青森县），女性从0.84（神奈川县）到1.11（鹿儿岛县），尽管自1995年以来两性中都有各都道府县不平等加剧的迹象。
结论
目前的研究结果表明，在过去30年里，日本全因死亡率的社会和地理不平等均有所增加。
Zotero 插件