Department Public Health and Statistics, Institute of Public Health, Brussels, Belgium.
Interface Demography, Section Social Research, Free University of Brussels, Brussels, Belgium.
Arch Public Health. 2014 Oct 1;72(1):34. doi: 10.1186/2049-3258-72-34. eCollection 2014.
Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008-2009 and the changes since 1993.
All deaths occurring in the periods 1993-1999 and 2003-2009, in people aged 1-74 residing in Belgium were included. The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database. Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths.
The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008-9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions. Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%. Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men.
Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.
降低过早死亡率是一个至关重要的公共卫生目标。在比利时死亡率统计数据长期中断后，本文介绍了 2008-2009 年导致过早死亡的主要原因和区域差异，以及自 1993 年以来的变化。
纳入了 1993-1999 年和 2003-2009 年期间居住在比利时的 1-74 岁人群中的所有死亡病例。比利时的死因和人口数据由比利时统计局提供，而国际比较数据则从世界卫生组织的死亡率数据库中提取。计算了年龄调整死亡率和人年生命损失（PYLL）。使用死亡率最低的地区或国家作为参照，计算了区域和国际比较的比率比；假设死亡人数的分布符合泊松分布，则对统计显著性进行了检验。
男性过早死亡率明显高于女性（分别占总死亡人数的 42%和 24%）。2008-9 年，比利时男性和女性的过早死亡率分别为每 10 万人 6410 和 3440 PYLL，在欧盟 15 国中分别排名第 4 和第 3。比利时各地区之间的差异很大：在整体过早死亡率方面，与佛兰德斯相比，瓦隆大区和布鲁塞尔大区的男性分别高出 40%和 20%，女性分别高出 30%和 20%。在特定死因死亡率方面，瓦隆大区也明显逊于佛兰德斯大区。布鲁塞尔在自然原因方面处于中等水平，但在外部原因方面排名不同，道路交通伤害和自杀事件较少，而非交通伤害事件较多。在 15 年期间，男性的年龄调整过早死亡率下降了 29%，女性下降了 22%。在男性中，循环系统疾病死亡率下降最快（-43.4%），其次是肿瘤（-26.6%）、其他自然原因（-21.0%）和外部原因（-20.8%）。胃癌（-48.4%）、道路交通伤害（-44%）、生殖器官（-40.4%）和肺部（-34.6%）癌症的单一死因下降幅度更大。相反，肝癌死亡率上升了 16%。在女性中，最显著的特征是肺癌死亡率上升了 50.2%。对于大多数其他原因，下降幅度略低于男性。
尽管随着时间的推移，过早死亡率负担的国际比较有所改善，但仍有改进的空间。瓦隆大区和布鲁塞尔大区的劣势表明社会经济因素的作用；精心设计的卫生政策有助于减少区域差异。女性肺癌死亡率的上升令人担忧。
