Klotz Johannes, Göllner Tobias, Gumprecht Nicole
Statistik Austria, Guglgasse 13, 1110, Wien, Österreich.
Z Gerontol Geriatr. 2019 Mar;52(2):130-138. doi: 10.1007/s00391-019-01523-5. Epub 2019 Mar 7.
Although socioeconomic differences in the mortality of middle-aged persons is well-researched, little is known about socioeconomic inequalities in mortality in the very old population. Surveys and population census follow-up studies in this age group are associated with reliability and validity problems.
The aim of the study was to investigate, by linking statistical information from register data, to what extent differences in mortality exist among very old Austrian men by socioeconomic variables (e.g. education and income) and if these can be explained by differences in health status.
The data records on men aged 80-99 years counted in the Austrian register-based population census from 2011 were augmented by information from tax and social security data and merged with deaths in a 5-year follow-up period. Relative mortality risks were estimated by Cox regression. The health status was operationalized by the standardized level of care.
Even in very old men significant differences in mortality exist depending on the socioeconomic status. A systematic effect was found for education and a poverty effect for income. When controlling not just for age but also for the standardized level of care, no socioeconomic disparities in mortality were observed. The higher mortality risk for less educated and low income very old men is thus a result of a poorer health status.
At ages over 80 years the health status is the essential influencing factor on mortality. Measures to reduce socioeconomic disparities in mortality must therefore focus on earlier phases in life, in order to reduce the extent of care dependency among socially disadvantaged groups.
尽管中年人的死亡率存在社会经济差异已得到充分研究，但对于高龄人群死亡率的社会经济不平等情况却知之甚少。针对这个年龄组的调查和人口普查随访研究存在可靠性和有效性问题。
本研究的目的是通过关联登记数据中的统计信息，调查奥地利高龄男性在死亡率方面因社会经济变量（如教育和收入）存在多大差异，以及这些差异是否可以由健康状况差异来解释。
2011年奥地利基于登记的人口普查中统计的80 - 99岁男性的数据记录，通过税收和社会保障数据中的信息进行补充，并与5年随访期内的死亡情况合并。通过Cox回归估计相对死亡风险。健康状况通过标准化护理水平来衡量。
即使在高龄男性中，死亡率也因社会经济地位存在显著差异。发现教育存在系统性影响，收入存在贫困影响。当不仅控制年龄，还控制标准化护理水平时，未观察到死亡率的社会经济差异。因此，受教育程度较低和低收入的高龄男性较高的死亡风险是健康状况较差的结果。
在80岁以上的年龄段，健康状况是影响死亡率的关键因素。因此，减少死亡率社会经济差异的措施必须侧重于生命的早期阶段，以减少社会弱势群体的护理依赖程度。
