Rahu Kaja, Rahu Mati, Zeeb Hajo
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.
BMJ Open. 2019 Jul 16;9(7):e026210. doi: 10.1136/bmjopen-2018-026210.
To quantify sex disparities in cause-specific premature adult mortality in Estonia, to determine the causes of death with the largest differences, to provide insight into related behaviours and to offer some guidance to public health policy-makers based on the results of the study.
A national register-based study.
Estonia.
Individual records of deaths at ages 20-69 years in 1995-2016 from the Estonian causes of death register; data on tobacco smoking and alcohol consumption in the adult population in 1996-2016 from the biennial postal survey of health behaviour.
Overall and cause-specific age-standardised mortality rates, average annual percentage changes in mortality, and cause-specific men-to-women mortality rate ratios were calculated. In addition, the age-standardised prevalence proportions of tobacco smoking and alcohol consumption and men-to-women prevalence rate ratios were determined.
Overall premature adult mortality decreased considerably during 1995-2016, but no reduction was observed with respect to the large relative sex disparities. In circulatory disease mortality, the disparities widened significantly over time. Extremely high mortality rate ratios were observed for cancer of the upper aerodigestive tract and for lung cancer. There was a stable, more than fivefold male excess mortality from external causes. A fourfold male disadvantage was evident for alcohol poisoning, mental disorders due to alcohol and alcohol-related degeneration of the nervous system as a group. The prevalence of tobacco smoking and harmful alcohol consumption among men exceeded that among women by factors of two and six, respectively.
Even though premature adult mortality has markedly decreased over time, there has been no success in diminishing the large sex differences in the mortality patterns, mostly associated with smoking and excessive alcohol consumption, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing antitobacco measures.
量化爱沙尼亚特定病因的成人过早死亡率中的性别差异，确定差异最大的死因，深入了解相关行为，并根据研究结果为公共卫生政策制定者提供一些指导。
一项基于全国登记册的研究。
爱沙尼亚。
1995 - 2016年爱沙尼亚死亡原因登记册中20 - 69岁人群的个体死亡记录；1996 - 2016年成人健康行为两年一次邮政调查中关于吸烟和饮酒的数据。
计算总体和特定病因的年龄标准化死亡率、死亡率的年均百分比变化以及特定病因的男女死亡率之比。此外，确定吸烟和饮酒的年龄标准化患病率以及男女患病率之比。
1995 - 2016年期间，总体成人过早死亡率大幅下降，但在较大的相对性别差异方面未见降低。在循环系统疾病死亡率方面，随着时间推移差异显著扩大。上呼吸道消化道癌症和肺癌的死亡率之比极高。外部原因导致的男性死亡率稳定地高出五倍多。酒精中毒、酒精所致精神障碍以及酒精相关神经系统变性这一组疾病中，男性劣势明显，为四倍。男性吸烟和有害饮酒的患病率分别比女性高出两倍和六倍。
尽管随着时间推移成人过早死亡率显著下降，但在减少死亡率模式中的巨大性别差异方面并未取得成功，这些差异主要与吸烟和过度饮酒有关，而这两者在男性中更为普遍。爱沙尼亚需要一项全面且一致的酒精政策，同时维持并进一步发展控烟措施。
