King's College London Institute of Psychiatry, Section of Epidemiology, Health Service and Population Research Department, London, United Kingdom.
PLoS Med. 2012 Feb;9(2):e1001179. doi: 10.1371/journal.pmed.1001179. Epub 2012 Feb 28.
Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking.
The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites.
Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.
即使在中低收入国家，大多数死亡也发生在老年人中。在欧洲，更好的教育和住房拥有权对死亡率的影响似乎一直持续到老年，但这些影响可能不适用于中低收入国家。缺乏关于死亡率原因和决定因素的可靠数据。
在拉丁美洲、印度和中国的多个地点，对 12373 名年龄在 65 岁及以上的人进行了 3-5 年的随访，以确定其生命状态。我们报告了粗死亡率和标准化死亡率、标准化死亡率比，用于比较死亡率与美国的死亡率，以及使用 Cox 比例风险回归估计与社会经济因素的关联。使用 InterVA 算法估计了特定原因的死亡率分数。粗死亡率从每 1000 人年 27.3 到 70.0 不等，在按人口和经济因素标准化后仍存在 3 倍的差异。与美国相比，印度城市和中国农村的死亡率要高得多，秘鲁、委内瑞拉和墨西哥城市的死亡率要低得多，其他地方的死亡率则相似。男性的死亡率较高，且随年龄增长而增加。在调整这些因素后发现，教育、职业成就、资产和养老金领取都与死亡率呈负相关，而粮食不安全则呈正相关。相互调整后，只有教育仍然具有保护作用（合并风险比 0.93，95%置信区间 0.89-0.98）。大多数死亡发生在家里，但除印度外，大多数人在临终前都接受了医疗照顾。慢性病是死亡的主要原因，结核病和肝病也占一定比例，在几乎所有地点中风都是主要死因。
教育似乎对老年人的死亡率有重要的潜在影响。然而，社会经济地位的构成差异并不能解释不同地点死亡率的差异。为老年人提供社会保护以及卫生系统在预防和治疗慢性病方面的有效性，可能与经济和人类发展同样重要。
