Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
AOK Niedersachsen (Local Statutory Health Insurance of Lower Saxony), Hildesheimer Strasse 273, 30519, Hannover, Germany.
Int J Public Health. 2019 Apr;64(3):387-397. doi: 10.1007/s00038-019-01224-1. Epub 2019 Mar 1.
International comparisons are suggesting that mortality inequalities may have changed in the last years, although not always into the same direction. Only a few studies examined myocardial infarction (MI). In our study, long-term developments of MI and all-cause mortality were considered by analysing social gradients by income.
German claims data covering 2006 to 2015 (N = 2,474,448) were used with myocardial infarction and all-cause mortality as outcomes. Socio-economic position was depicted by individual income. Health inequalities were measured by hazard ratios between and within income groups for 10 consecutive calendar years.
In men, income gradients of MI and all-cause mortality were decreasing. In women, no income gradients emerged for MI, and they disappeared in mortality. In men, hazard ratios of MI and mortality decreased in the intermediate and in the lowest income thirds, thus leading to a reduction of MI-related health inequalities.
Income inequalities in terms of myocardial infarction and of mortality have narrowed in men, and those in the lowest income third were profiting most. No such changes were observed in women.
国际比较表明，近年来死亡率不平等可能已经发生了变化，尽管并不总是朝着同一个方向。只有少数研究检查了心肌梗死（MI）。在我们的研究中，通过分析收入的社会梯度，考虑了 MI 和全因死亡率的长期发展。
使用德国索赔数据（2006 年至 2015 年）（N=2,474,448），以心肌梗死和全因死亡率为结局。社会经济地位由个人收入来描述。健康不平等程度通过 10 个连续日历年的收入组间和组内的风险比来衡量。
在男性中，MI 和全因死亡率的收入梯度呈下降趋势。在女性中，MI 没有出现收入梯度，而死亡率则没有。在男性中，MI 和死亡率的风险比在中间和最低收入三分之一中下降，从而减少了与 MI 相关的健康不平等。
男性的心肌梗死和死亡率方面的收入不平等已经缩小，最低收入三分之一的人受益最大。女性没有观察到这种变化。
