NHS National Services Scotland, Glasgow, UK.
Glasgow Centre for Population Health, Glasgow, UK.
Public Health. 2015 Jun;129(6):684-90. doi: 10.1016/j.puhe.2015.02.032. Epub 2015 Apr 17.
A previous investigation of Glasgow's excess mortality showed that the (income) deprivation profiles for Glasgow, Liverpool and Manchester were nearly identical. Despite this, premature deaths in Glasgow were found to be more than 30% higher, and all deaths 15% higher, than in the English cities. This study aimed to explore the extent to which Glasgow's higher mortality could be explained by the use of a potentially more sensitive measure of deprivation employed at a suitably small and consistent geographical spatial unit.
Analyses of mortality based on the creation of a three-city index of deprivation using rates of 'car/van ownership' deprivation for small areas (average population size: 1600) in Glasgow, Liverpool and Manchester derived from the census.
Rates of 'car/van ownership deprivation were calculated for small areas in Glasgow, Liverpool and Manchester. All-cause and cause-specific standardized mortality ratios were calculated for Glasgow relative to Liverpool and Manchester, standardizing for age, gender and deprivation decile.
The overall levels of car/van ownership based deprivation in Glasgow, Liverpool and Manchester, in 2001, differed. Glasgow had a higher percentage of its population who did not have access to a car compared with Liverpool and Manchester. All-cause mortality, after adjustment for age, sex and this measure of deprivation, for deaths <65 years were 15% higher and 8% higher for all deaths for males and females respectively. However, this was lower than the excess observed in the previous study. 'Excess' mortality was greatest in the working age groups of 15-44 years and 45-64 years, where it was 23% and 15% higher respectively. For deaths at all ages after adjustment, analysis by deprivation decile showed that excess mortality in Glasgow was seen in half the deciles, including four of the five most deprived deciles. However, the greatest excess was seen in comparison of the least deprived neighbourhoods. For premature mortality (deaths under 65 years), the excess was mainly driven by higher mortality in the five most deprived deciles (6-10); again, however, a high excess was seen in comparisons of the least deprived areas.
The higher mortality in Glasgow compared to equally income-deprived Liverpool and Manchester cannot be fully explained by a deprivation index based on lack of access to a car or van, but this index does explain more of the excess than income deprivation. Further work to establish better measures of deprivation and to explain this excess are required.
之前对格拉斯哥超额死亡率的调查表明，格拉斯哥、利物浦和曼彻斯特的（收入）贫困状况几乎相同。尽管如此，格拉斯哥的过早死亡率却高出 30%以上，所有死亡率高出 15%。本研究旨在探讨在使用更敏感的贫困衡量标准，并在适当小且一致的地理空间单位上应用时，格拉斯哥更高的死亡率在多大程度上可以得到解释。
使用从人口普查中得出的格拉斯哥、利物浦和曼彻斯特小型地区（平均人口规模为 1600 人）的“汽车/货车拥有率”贫困率创建一个三城市贫困指数，对死亡率进行分析。
为格拉斯哥、利物浦和曼彻斯特的小型地区计算“汽车/货车拥有率”贫困率。针对格拉斯哥相对于利物浦和曼彻斯特的全因和特定原因标准化死亡率比进行计算，标准化因素为年龄、性别和贫困阶层。
2001 年，格拉斯哥、利物浦和曼彻斯特的基于汽车/货车拥有率的贫困水平总体不同。格拉斯哥没有汽车的人口比例高于利物浦和曼彻斯特。在调整年龄、性别和这种贫困衡量标准后，<65 岁的全因死亡率对于男性和女性分别高出 15%和 8%，所有死亡原因的死亡率也高出 8%。然而，这低于之前研究中观察到的超额死亡率。“超额”死亡率在 15-44 岁和 45-64 岁的工作年龄组中最高，分别高出 23%和 15%。在调整所有年龄的死亡后，按贫困阶层进行分析表明，格拉斯哥的超额死亡率出现在一半的贫困阶层中，包括五个最贫困阶层中的四个。然而，最大的超额死亡率出现在最贫困社区的比较中。对于过早死亡率（<65 岁的死亡），超额死亡率主要是由五个最贫困阶层（6-10）的更高死亡率驱动的；然而，在最贫困地区的比较中也观察到了很高的超额死亡率。
格拉斯哥与收入同样贫困的利物浦和曼彻斯特相比，死亡率更高，不能完全用基于无法获得汽车或货车的贫困指数来解释，但该指数确实比收入贫困指数能更好地解释这种超额死亡率。需要进一步的工作来建立更好的贫困衡量标准，并解释这种超额死亡率。
