Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
PLoS One. 2020 Apr 2;15(4):e0230684. doi: 10.1371/journal.pone.0230684. eCollection 2020.
This study aimed to characterize trends in absolute and relative socioeconomic inequalities in adult premature mortality between 1992 and 2017, in the context of declining population-wide mortality rates. We conducted a population-based cohort study of all adult premature deaths in Ontario, Canada using provincial vital statistics data linked to census-based, area-level deprivation indices for socioeconomic status.
The cohort included all individuals eligible for Ontario's single-payer health insurance system at any time between January 1, 1992 and December 31, 2017 with a recorded Ontario place of residence and valid socioeconomic status information (N = 820,370). Deaths between ages 18 and 74 were used to calculate adult premature mortality rates per 1000, stratified by provincial quintile of material deprivation. Relative inequalities were measured using Relative Index of Inequality (RII) measures. Absolute inequalities were estimated using Slope Index of Inequality (SII) measures. All outcome measures were calculated as sex-specific, annual measures for each year from 1992 to 2017.
Premature mortality rates declined in all socioeconomic groups between 1992 and 2017. Relative inequalities in premature mortality increased over the same period. Absolute inequalities were mostly stable between 1992 and 2007, but increased dramatically between 2008 and 2017, with larger increases to absolute inequalities seen in females than in males.
As in other developed countries, long-term downward trends in all-cause premature mortality in Ontario, Canada have shifted to a plateau pattern in recent years, especially in lower- socioeconomic status subpopulations. Determinants of this may differ by setting. Regular monitoring of mortality by socioeconomic status is the only way that this phenomenon can be detected sensitively and early, for public health attention and possible corrective action.
本研究旨在描述 1992 年至 2017 年期间，在人口死亡率下降的背景下，绝对和相对社会经济不平等对成年人早逝的趋势。我们使用省级生命统计数据，结合基于人口普查的、按地区划分的社会经济地位剥夺指数，对加拿大安大略省所有成年人早逝进行了基于人群的队列研究。
该队列包括 1992 年 1 月 1 日至 2017 年 12 月 31 日期间任何时候有资格参加安大略省单一支付者医疗保险系统的所有个体，其记录有安大略省居住地和有效的社会经济地位信息（N=820370）。使用物质剥夺程度的省级五分位数，计算 18 至 74 岁之间的成年人早逝死亡率，以每 1000 人计算。使用相对不平等指数（RII）衡量相对不平等程度。使用斜率指数的不平等（SII）来估计绝对不平等。所有结果衡量指标均作为性别特定的每年衡量指标，从 1992 年到 2017 年每年计算一次。
1992 年至 2017 年，所有社会经济群体的早逝率均下降。同期，早逝的相对不平等程度增加。1992 年至 2007 年期间，绝对不平等程度基本稳定，但 2008 年至 2017 年期间急剧增加，女性的绝对不平等程度增加幅度大于男性。
与其他发达国家一样，加拿大安大略省全因早逝的长期下降趋势近年来已趋于平稳，尤其是在社会经济地位较低的亚人群中。造成这种情况的原因可能因环境而异。定期按社会经济地位监测死亡率是一种敏感、早期发现这种现象的唯一方法，以便引起公共卫生关注并采取可能的纠正措施。
