Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
Centre for research in Epidemiology and Population Health (CESP), U1018, INSERM, Villejuif, France University of Versailles Saint Quentin, Versailles, France.
J Epidemiol Community Health. 2015 Mar;69(3):207-17; discussion 205-6. doi: 10.1136/jech-2014-204319. Epub 2014 Jun 25.
Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century.
We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia.
Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries.
Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.
在 20 世纪的最后几十年，许多欧洲国家报告称，社会经济上层和下层人群的死亡率差距不断扩大。对于大多数国家而言，尚不清楚这种差距在 21 世纪的第一个十年是否仍在继续扩大。
我们收集并协调了所有有数据可用的国家（芬兰、瑞典、挪威、丹麦、英格兰和威尔士、比利时、法国、瑞士、西班牙、意大利、匈牙利、立陶宛和爱沙尼亚）中 30-74 岁男性和女性按教育程度划分的死亡率数据。
在欧洲北部、西部和东部的大多数人群中，过早死亡率的相对不平等程度有所增加，但在南部则没有。这主要是由于受教育程度较低的人群的死亡率降幅小于受教育程度较高的人群，但在立陶宛和爱沙尼亚，受教育程度较低的人群的死亡率上升，而受教育程度较高的人群的死亡率下降。在许多国家，由于与吸烟（仅限女性）和过度饮酒（肝硬化和外部原因）相关的疾病，受教育程度较低的人群的死亡率上升。然而，从绝对值来看，许多国家受教育程度较低的人群的过早死亡率降幅更大，这主要是由于心血管疾病和癌症（仅限男性）的死亡率绝对降幅更大。尽管教育水平有所提高，但许多国家受教育程度较低人群的死亡率归因比例仍在上升。
在大多数欧洲国家，过早死亡率的相对不平等程度仍在继续上升，自 20 世纪 90 年代以来，南欧（不平等程度较小）和东欧（不平等程度较大）之间的差距进一步拉大。尽管这些不平等现象对人口的影响进一步增加，但许多国家受教育程度较低人群的死亡率绝对降幅更大，这也带来了一些令人鼓舞的迹象。要降低死亡率的不平等程度，关键是要加快受教育程度较低人群的死亡率下降速度，并遏制与吸烟和过度饮酒相关的疾病（如肺癌、肝硬化和外部原因）导致的死亡率上升。
