Lim Dohee, Kong Kyoung Ae, Lee Hye Ah, Lee Won Kyung, Park Su Hyun, Baik Sun Jung, Park Hyesook, Jung-Choi Kyunghee
Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
Clinical Trial Center, Ewha Womans University Medical Center, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
BMC Public Health. 2015 Mar 31;15:313. doi: 10.1186/s12889-015-1665-x.
The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels.
National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30-44 and 45-59 years).
The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30-44 years. However, the PAFs of suicide in younger females (30-44 years) and of cerebrovascular disease in older males (45-59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30-44 years.
The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies.
韩国人的教育水平有了大幅提高，预计这会降低与低教育水平相关的死亡人群归因分数（PAF）。然而，低教育水平人群死亡率的相对风险（RR）增加，实际上却提高了PAF。本研究的目的是考察韩国低教育水平人群死亡PAF的变化情况，在韩国，教育水平提高了，但这与死亡率不平等加剧有关。
使用全国人口普查数据得出教育水平。参照1995年、2000年、2005年和2010年的全国人口普查及死亡证明数据，计算低教育水平与死亡率相关的RR。按性别和年龄组（30 - 44岁和45 - 59岁）计算全因死亡率、恶性肿瘤、脑血管疾病、心脏病和自杀的PAF。
自1995年以来，两性中低教育水平人群的全因死亡率PAF均有所下降。这一趋势在30 - 44岁人群中更为显著。然而，年轻女性（30 - 44岁）自杀的PAF以及老年男性（45 - 59岁）脑血管疾病的PAF有所增加。教育水平最低人群的全因死亡率RR以及四大主要死因的RR均有所增加，尤其是在30 - 44岁的女性中。
尽管死亡率不平等状况并未改善，但教育水平持续大幅提高有助于降低低教育水平人群的死亡PAF。减少健康不平等的努力必须促进健康的公共政策并解决公共卫生政策问题。
