Gartner Andrea, Farewell Daniel, Greene Giles, Trefan Laszlo, Davies Alisha, Fone David, Paranjothy Shantini
Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, United Kingdom.
Public Health Wales NHS Trust, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, United Kingdom.
SSM Popul Health. 2018 May 24;5:48-54. doi: 10.1016/j.ssmph.2018.05.004. eCollection 2018 Aug.
Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.
近期研究发现了健康选择性迁移的证据，即健康的人迁往贫困程度较低的地区，而健康状况较差的人则迁往或留在贫困程度较高的地区。然而，对于这是否会影响健康不平等，目前尚无定论。政府和卫生服务部门广泛使用死亡率和预期寿命方面的社会经济不平等指标来跟踪随时间的变化，但并未考虑迁移的影响。本研究旨在调查迁移是否以及在多大程度上改变了观察到的死亡率方面的社会经济梯度。2006年1月1日在国民保健服务体系登记的威尔士人口（3136881人）的数据以及24个季度的随访数据被单独记录链接到国家统计局的死亡率档案。这包括每个季度、年龄、性别和死亡日期在较低超级输出区（LSOA）、贫困五分位数和城乡类别之间的迁移情况。使用Cox回归模型估计全因死亡率中贫困五分位数的风险比，以及研究开始和结束之间的贫困变化。我们发现一些群体存在健康选择性迁移的证据，例如75岁以下的人离开最贫困地区，其死亡风险高于留在原地的人，这表明不平等在加剧，但也发现其他迁移群体呈现相反的模式。对于所有年龄段，生活在最贫困五分位数的人死亡风险比最不贫困五分位数的人高57%，且贫困程度会随时间的迁移而变化。当人为地将人们保持在其初始贫困五分位数时，这种风险变化不大（高54%）。总体而言，在2006年至2011年的六年期间内，威尔士的迁移并未显著改变死亡率方面的贫困梯度。
