Ribeiro Ana Isabel, Krainski Elias Teixeira, Carvalho Marilia Sá, De Fátima de Pina Maria
EPIUnit-Instituto de Saúde Pública, Universidade do Porto; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto; INEB-Instituto de Engenharia Biomédica, Universidade do Porto; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School.
Geospat Health. 2017 Nov 7;12(2):581. doi: 10.4081/gh.2017.581.
Spatial inequalities in old-age survival exist in Portugal and might be associated with factors pertaining to three distinct domains: socioeconomic, physical environmental and healthcare. We evaluated the contribution of these factors on the old-age survival across Portuguese municipalities deriving a surrogate measure of life expectancy, a 10-year survival rate that expresses the proportion of the population aged 75-84 years old who reached 85-94. As covariates we used two internationally comparable multivariate indexes: the European deprivation index and the multiple physical environmental deprivation index. A national index was developed to evaluate the access to healthcare. Smoothed rates and odds ratios (OR) were estimated using Bayesian spatial models. Socioeconomic deprivation was found to be the most relevant factor influencing old-age survival in Portugal [women: least deprived areas OR=1.132(1.064-1.207); men OR=1.044(1.001- 1.094)] and explained a sizable amount of the spatial variance in survival, especially among women. Access to healthcare was associated with old-age survival in the univariable model only; results lost significance after adjustment for socioeconomic circumstances [women: higher access to healthcare OR=1.020(0.973- 1.072); men OR=1.021(0.989-1.060)]. Physical environmental deprivation was unrelated with old-age survival. In conclusion, socioeconomic deprivation was the most important determinant in explaining spatial disparities in old-age survival in Portugal, which indicates that policy makers should direct their efforts to tackle socioeconomic differentials between regions.
葡萄牙存在老年人生存方面的空间不平等现象，这可能与三个不同领域的因素有关：社会经济、自然环境和医疗保健。我们评估了这些因素对葡萄牙各城市老年人生存的影响，得出了预期寿命的替代指标，即10年生存率，该指标表示75 - 84岁人群中活到85 - 94岁的人口比例。作为协变量，我们使用了两个国际可比的多变量指数：欧洲贫困指数和多重自然环境剥夺指数。还制定了一个国家指数来评估医疗保健的可及性。使用贝叶斯空间模型估计平滑率和比值比（OR）。研究发现，社会经济剥夺是影响葡萄牙老年人生存的最相关因素[女性：最不贫困地区OR = 1.132(1.064 - 1.207)；男性OR = 1.044(1.001 - 1.094)]，并解释了生存空间差异的很大一部分，尤其是在女性中。医疗保健的可及性仅在单变量模型中与老年人生存相关；在调整社会经济状况后，结果失去了显著性[女性：医疗保健可及性较高OR = 1.020(0.973 - 1.072)；男性OR = 1.021(0.989 - 1.060)]。自然环境剥夺与老年人生存无关。总之，社会经济剥夺是解释葡萄牙老年人生存空间差异的最重要决定因素，这表明政策制定者应努力解决地区间的社会经济差异。
