Department of Preventive Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
Soc Sci Med. 2019 Sep;237:112482. doi: 10.1016/j.socscimed.2019.112482. Epub 2019 Aug 7.
This study aimed to estimate age-period-cohort effects on avoidable mortality and quantify the impact of avoidable mortality changes on life expectancy (LE) at birth in the South Korean population aged 0-74 years. Using death certificate and resident population data from 2000 to 2017, trends in age-standardized avoidable mortality rates were analyzed with joinpoint regression. Intrinsic estimator regression analysis was conducted to estimate age-period-cohort effects on avoidable mortality. Arriaga's method was used to measure the contributions of avoidable causes to changes in LE gaps between adjacent three-year periods by age and avoidable cause of death groups. Avoidable mortality decreased annually by 4.6% between 2000 and 2017. There were strong age and cohort effects and a weak period effect on avoidable mortality. In the overall decreasing trend, avoidable mortality declined less in cohorts born after the 1950-1953 Korean War and economic recession in the 1970s, with further reductions in cohorts born after the 1987 democratic reform and 1997-1998 economic crisis. Avoidable mortality was reduced after implementation of major health policies, but the decrease stagnated during the 2008-2009 financial crisis. Avoidable mortality reduction resulted in LE gains of 3.1 years, which accounted for 80% of total LE gains. Contribution to LE gains by causes of death was the largest for cerebrovascular disease. Major social changes and health policies influenced the avoidable mortality trend through cohort and period effects. Health care and public health policies implemented since the 2000s might have contributed substantially to gains in LE.
本研究旨在估计可避免死亡率的年龄-时期-队列效应，并量化可避免死亡率变化对韩国 0-74 岁人群出生期望寿命（LE）的影响。使用 2000 年至 2017 年的死亡证明和居民人口数据，采用 Joinpoint 回归分析了年龄标准化可避免死亡率的趋势。采用内在估计量回归分析估计了可避免死亡率的年龄-时期-队列效应。采用 Arriaga 方法，按年龄和可避免死因组测量相邻三年期 LE 差距变化中可避免死因的贡献。2000 年至 2017 年，可避免死亡率每年下降 4.6%。可避免死亡率存在显著的年龄和队列效应以及较弱的时期效应。在整体下降趋势中，出生于朝鲜战争和 20 世纪 70 年代经济衰退后 1950-1953 年的队列以及出生于 20 世纪 80 年代民主改革和 1997-1998 年经济危机后的队列的可避免死亡率下降幅度较小。重大卫生政策实施后可避免死亡率降低，但 2008-2009 年金融危机期间死亡率下降停滞。可避免死亡率的降低导致 LE 增加 3.1 年，占 LE 总增加量的 80%。死因对 LE 增加的贡献以脑血管病最大。主要的社会变化和卫生政策通过队列和时期效应影响可避免死亡率趋势。自 21 世纪以来实施的医疗保健和公共卫生政策可能对 LE 的增加做出了重大贡献。
