Ribeiro Ana Isabel, Krainski Elias Teixeira, Carvalho Marilia Sá, Pina Maria de Fátima de
i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal ISPUP-Institute of Public Health, University of Porto, Porto, Portugal Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
The Norwegian University for Science and Technology, Trondheim, Norway Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil.
J Epidemiol Community Health. 2016 Jun;70(6):561-8. doi: 10.1136/jech-2015-206827. Epub 2016 Feb 15.
Further increases in life expectancy in high-income countries depend to a large extent on advances in old-age survival. We aimed to characterise the spatial distribution of old-age survival across small areas of Europe, and to identify areas with significantly high or low survivorship.
This study incorporated 4404 small areas from 18 European countries. We used a 10-year survival rate to express the proportion of population aged 75-84 years who reached 85-94 years of age (beyond average life expectancy). This metric was calculated for each gender using decennial census data (1991, 2001 and 2011) at small geographical areas. To address problems associated with small areas, rates were smoothed using a Bayesian spatial model. Excursion sets were defined to identify areas with significantly high (>95th centile) and low (<5th) survival.
In 2011, on average, 47.1% (range: 22.5-71.5) of the female population aged 75-84 years had reached 85-94 years of age, compared to 34.2% (16.4-49.6) of the males. These figures, however, hide important and time-persistent spatial inequalities. Higher survival rates were concentrated in northern Spain, Andorra and northeastern Italy, and in the south and west of France. Lower survival was found in parts of the UK, Scandinavia and the Netherlands, and in some areas of southern Europe. Within these regions, we detected areas with significantly high and low old-age survival.
Clear and persistent spatial inequalities in old-age survival exist, suggesting that European social unity is still to be accomplished. These inequalities could arise from a myriad of population health determinants (eg, poverty, unhealthy lifestyles), which merit further study.
高收入国家预期寿命的进一步提高在很大程度上取决于老年生存率的进步。我们旨在描述欧洲小区域老年生存率的空间分布，并确定生存率显著高或低的地区。
本研究纳入了来自18个欧洲国家的4404个小区域。我们使用10年生存率来表示75 - 84岁人群活到85 - 94岁（超过平均预期寿命）的比例。该指标是使用小地理区域的十年一次人口普查数据（1991年、2001年和2011年）按性别分别计算的。为解决与小区域相关的问题，使用贝叶斯空间模型对率进行平滑处理。定义偏移集以识别生存率显著高（>第95百分位数）和低（<第5百分位数）的地区。
2011年，平均而言，75 - 84岁的女性人口中有47.1%（范围：22.5% - 71.5%）活到了85 - 94岁，而男性为34.2%（16.4% - 49.6%）。然而，这些数字掩盖了重要且长期存在的空间不平等。较高的生存率集中在西班牙北部、安道尔和意大利东北部，以及法国南部和西部。较低的生存率出现在英国部分地区、斯堪的纳维亚和荷兰，以及南欧的一些地区。在这些区域内，我们检测到了老年生存率显著高和低的地区。
老年生存率存在明显且持续的空间不平等，这表明欧洲社会的团结仍有待实现。这些不平等可能源于众多人口健康决定因素（如贫困、不健康的生活方式），值得进一步研究。
