Department of Society, Human Development and Health Harvard School of Public Health, Boston, MA 02115, USA.
Int J Health Serv. 2012;42(2):293-322. doi: 10.2190/HS.42.2.i.
Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that U.S. socioeconomic inequalities in overall mortality shrank between the mid-1960s and 1980. The authors accordingly analyzed U.S. mortality data for 1960-2006, stratified by county income quintile and race/ethnicity, for mortality unrelated to smoking and preventable by 1960s' standards of medical care. Key findings are that relative and absolute socioeconomic inequalities in U.S. mortality unrelated to smoking and preventable by 1960s' medical care standards shrank between the 1960s and 1980 and then increased and stagnated, with absolute rates on a par with several leading causes of death, and with the burden greatest for U.S. populations of color. None of these findings can be attributed to trends in smoking-related deaths and access to high-tech medicine, and they also demonstrate that socioeconomic inequities in mortality can shrink and need not inevitably rise.
最近关于美国在 1980 年后在死亡率方面的社会经济不平等现象扩大的研究强调了吸烟和高科技医学的贡献，一些研究将不断扩大的不平等现象视为不可避免。然而，没有研究分析与吸烟无关或由于缺乏基本医疗保健而导致的美国死亡率和不平等现象的长期趋势，尽管有少数研究表明，美国在整体死亡率方面的社会经济不平等现象在 20 世纪 60 年代中期至 1980 年间有所缩小。因此，作者分析了美国 1960 年至 2006 年的死亡率数据，按县收入五分位数和种族/族裔进行分层，这些数据与吸烟无关，并且可以通过 20 世纪 60 年代的医疗保健标准来预防。主要发现是，与吸烟无关且可以通过 20 世纪 60 年代的医疗保健标准预防的美国死亡率方面的相对和绝对社会经济不平等现象在 20 世纪 60 年代至 80 年代期间缩小，然后增加并停滞不前，其绝对死亡率与一些主要死亡原因相当，并且对美国有色人种的负担最大。这些发现都不能归因于与吸烟相关的死亡人数和获得高科技医学的趋势，而且它们还表明，死亡率方面的社会经济不平等现象可以缩小，而不必不可避免地增加。
