Bremberg Sven G
1 Department of Public Health, Karolinska Institute, Sweden.
2 Public Health Agency of Sweden, Sweden.
Scand J Public Health. 2017 Jun;45(4):436-443. doi: 10.1177/1403494816685529. Epub 2017 Jan 12.
Since the scientific revolution of the 18th century, human health has gradually improved, but there is no unifying theory that explains this improvement in health. Studies of macrodeterminants have produced conflicting results. Most studies have analysed health at a given point in time as the outcome; however, the rate of improvement in health might be a more appropriate outcome.
Twenty-eight OECD member countries were selected for analysis in the period 1990-2010. The main outcomes studied, in six age groups, were the national rates of decrease in mortality in the period 1990-2010. The effects of seven potential determinants on the rates of decrease in mortality were analysed in linear multiple regression models using least squares, controlling for country-specific history constants, which represent the mortality rate in 1990.
The multiple regression analyses started with models that only included mortality rates in 1990 as determinants. These models explained 87% of the intercountry variation in the children aged 1-4 years and 51% in adults aged 55-74 years. When added to the regression equations, the seven determinants did not seem to significantly increase the explanatory power of the equations.
The analyses indicated a decrease in mortality in all nations and in all age groups. The development of mortality rates in the different nations demonstrated significant catch-up effects. Therefore an important objective of the national public health sector seems to be to reduce the delay between international research findings and the universal implementation of relevant innovations.
自18世纪科学革命以来,人类健康状况逐渐改善,但尚无统一理论来解释这种健康改善情况。宏观决定因素的研究结果相互矛盾。大多数研究将特定时间点的健康状况作为结果进行分析;然而,健康改善率可能是更合适的结果。
选取28个经合组织成员国在1990年至2010年期间进行分析。研究的主要结果是六个年龄组在1990年至2010年期间的全国死亡率下降率。使用最小二乘法在多元线性回归模型中分析七个潜在决定因素对死亡率下降率的影响,并控制代表1990年死亡率的特定国家历史常数。
多元回归分析首先从仅将1990年死亡率作为决定因素的模型开始。这些模型解释了1至4岁儿童国家间差异的87%以及55至74岁成年人国家间差异的51%。当将这七个决定因素添加到回归方程中时,它们似乎并未显著提高方程的解释力。
分析表明所有国家和所有年龄组的死亡率均有所下降。不同国家死亡率的发展呈现出显著的追赶效应。因此,国家公共卫生部门的一个重要目标似乎是减少国际研究结果与相关创新普遍实施之间的延迟。