Fraser Simon Ds, George Steve
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.
Risk Manag Healthc Policy. 2015 Jun 17;8:99-110. doi: 10.2147/RMHP.S68925. eCollection 2015.
Several health outcomes (including mortality) and health-related behaviors are known to be worse in Scotland than in comparable areas of Europe and the United Kingdom. Within Scotland, Greater Glasgow (in West Central Scotland) experiences disproportionately poorer outcomes independent of measurable variation in socioeconomic status and other important determinants. Many reasons for this have been proposed, particularly related to deprivation, inequalities, and variation in health behaviors. The use of models (such as the application of Bradford Hill's viewpoints on causality to the different hypotheses) has provided useful insights on potentially causal mechanisms, with health behaviors and inequalities likely to represent the strongest individual candidates. This review describes the evolution of our understanding of Glasgow's excess mortality, summarizes some of the key work in this area, and provides some suggestions for future areas of exploration. In the context of demographic change, the experience in Glasgow is an important example of the complexity that frequently lies behind observed variations in health outcomes within and between populations. A comprehensive explanation of Glasgow's excess mortality may continue to remain elusive, but is likely to lie in a complex and difficult-to-measure interplay of health determinants acting at different levels in society throughout the life course. Lessons learned from the detailed examination of different potentially causative determinants in Scotland may provide useful methodological insights that may be applied in other settings. Ongoing efforts to unravel the causal mechanisms are needed to inform public health efforts to reduce health inequalities and improve outcomes in Scotland.
众所周知，苏格兰的一些健康指标（包括死亡率）及与健康相关的行为状况比欧洲和英国其他可比地区更差。在苏格兰境内，大格拉斯哥地区（位于苏格兰中西部）的健康状况格外糟糕，且与社会经济地位及其他重要决定因素的可衡量差异无关。对此人们提出了诸多原因，尤其涉及贫困、不平等以及健康行为的差异。运用模型（例如将布拉德福德·希尔的因果关系观点应用于不同假设）为潜在的因果机制提供了有益见解，其中健康行为和不平等现象可能是最主要的个体因素。本综述描述了我们对格拉斯哥过高死亡率认识的演变过程，总结了该领域的一些关键研究工作，并为未来的探索方向提供了一些建议。在人口结构变化的背景下，格拉斯哥的情况是一个重要例证，它体现了人群内部和人群之间健康指标差异背后常常存在的复杂性。对格拉斯哥过高死亡率的全面解释可能仍然难以捉摸，但很可能在于贯穿整个生命历程、在社会不同层面发挥作用的健康决定因素之间复杂且难以衡量的相互作用。从对苏格兰不同潜在致病决定因素的详细研究中吸取的经验教训，可能会提供有用的方法学见解，这些见解可应用于其他环境。为了指导苏格兰减少健康不平等现象并改善健康状况的公共卫生工作，需要持续努力来揭示因果机制。
