Universidad Internacional de Valencia, Área de empresa, c/Pintor Sorolla, Valencia, 21, 46022, Spain.
Centro de Gestión de la Calidad y del Cambio, Universitat Politècnica de València, Camino de Vera, s/n, Valencia, 46022, Spain.
Int J Equity Health. 2018 Mar 27;17(1):38. doi: 10.1186/s12939-018-0750-z.
Mortality decreased in European Union (EU) countries during the last century. Despite these similar trends, there are still considerable differences in the levels of mortality between Eastern and Western European countries. Sub-group analysis of mortality in Europe for different age and sex groups is common, however to our knowledge a spatio-temporal methodology as in this study has not been applied to detect significant spatial dependence and interaction with time. Thus, the objective of this paper is to quantify the dynamics of mortality in Europe and detect significant clusters of mortality between European countries, applying spatio-temporal methodology. In addition, the joint evolution between the mortality of European countries and their neighbours over time was studied.
The spatio-temporal methodology used in this study takes into account two factors: time and the geographical location of countries and, consequently, the neighbourhood relationships between them. This methodology was applied to 26 European countries for the period 1990-2012.
Principally, for people older than 64 years two significant clusters were obtained: one of high mortality formed by Eastern European countries and the other of low mortality composed of Western countries. In contrast, for ages below or equal to 64 years only the significant cluster of high mortality formed by Eastern European countries was observed. In addition, the joint evolution between the 26 European countries and their neighbours during the period 1990-2012 was confirmed. For this reason, it can be said that mortality in EU not only depends on differences in the health systems, which are a subject to national discretion, but also on supra-national developments.
This paper proposes statistical tools which provide a clear framework for the successful implementation of development public policies to help the UE meet the challenge of rethinking its social model (Social Security and health care) and make it sustainable in the medium term.
上个世纪，欧盟（EU）国家的死亡率有所下降。尽管这些趋势相似，但东欧和西欧国家之间的死亡率水平仍存在相当大的差异。对欧洲不同年龄和性别群体的死亡率进行亚组分析很常见，但据我们所知，像本研究这样的时空方法尚未应用于检测死亡率的显著空间相关性和与时间的相互作用。因此，本文的目的是量化欧洲的死亡率动态，并检测欧洲国家之间死亡率的显著聚类，应用时空方法。此外，还研究了欧洲国家及其邻国的死亡率随时间的共同演变。
本研究中使用的时空方法考虑了两个因素：时间和国家的地理位置，因此，考虑了它们之间的邻里关系。该方法应用于 1990-2012 年期间的 26 个欧洲国家。
主要是，对于年龄在 64 岁以上的人，发现了两个显著的聚类：一个由东欧国家组成的高死亡率聚类，另一个由西方国家组成的低死亡率聚类。相比之下，对于年龄在 64 岁以下或等于 64 岁的人，仅观察到由东欧国家组成的高死亡率显著聚类。此外，还证实了 1990-2012 年期间 26 个欧洲国家与其邻国之间的共同演变。因此，可以说欧盟的死亡率不仅取决于各国自行决定的卫生系统差异，还取决于超国家的发展。
本文提出了统计工具，为成功实施发展公共政策提供了明确的框架，以帮助欧盟迎接重新思考其社会模式（社会保障和医疗保健）的挑战，并使其在中期具有可持续性。
