Lehikoinen Markku, Arffman Martti, Manderbacka Kristiina, Elovainio Marko, Keskimäki Ilmo
Department of Social Services and Health Care, City of Helsinki, P.O. Box 6100, 00099, Helsinki, Finland.
Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20 , Tukholmankatu 8 B, 00014, Helsinki, Finland.
Int J Equity Health. 2016 Apr 5;15:59. doi: 10.1186/s12939-016-0348-2.
Large cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.
We analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992-2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.
While mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas.
No geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.
由于居住分化加剧，大城市往往被认为比其他地区表现出更明显的地理和社会经济健康不平等。我们的目的是评估首都（赫尔辛基市）内死亡率的地理不平等是否超过芬兰其他类型地理区域的不平等，以及这些差异是否依赖于社会经济不平等。
我们分别分析了1992 - 2008年芬兰三种地理区域（赫尔辛基市、其他大城市以及小城镇和农村地区）总体、缺血性心脏病、与酒精相关的死亡率以及可通过医疗保健干预改善的死亡率（AM）的分布不平等情况。死亡率数据作为二手数据从芬兰统计局的死亡原因统计中获取。使用基尼系数对随时间变化的地理差异（即地理不平等）进行评估。由于其中一些差异可能源于社会经济因素，我们在分析地理差异的同时，使用集中指数评估社会经济差异。为完成分析，我们比较了这三个地理区域之间这些不平等随时间的变化情况。
虽然死亡率总体呈下降趋势，但最低收入五分位数人群中与酒精相关的死亡率有所上升。在所有死亡率组中均发现了随时间的统计学显著差异，不同地理区域之间存在差异。所有死亡率组和地理区域都存在社会经济差异。在研究期间，死亡率的地理差异保持相对稳定，但收入差异大幅增加。例如，男性AM的集中指数值变化了54%（p < 0.027），女性变化了62%（p < 0.016）。不同地理区域之间基尼系数或集中指数的时间趋势仅存在细微差异。
芬兰赫尔辛基与其他城市或农村地区在死亡率分布上不存在地理或收入相关差异。这表明首都居住分化加剧的影响可能已通过积极的歧视政策和社会融合得到缓解。健康不平等加剧的主要原因之一是与酒精相关的死亡率上升，尤其是在收入最低的人群中。
