Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogota, Colombia
Ciencias de la Salud, Universidad de la Costa-CUC, Barranquilla, Colombia.
BMJ Open Respir Res. 2020 Nov;7(1). doi: 10.1136/bmjresp-2020-000695.
To explore the existence and trends of social inequalities related to pneumonia mortality in Colombian adults using educational level as a proxy of socioeconomic status.
We obtained individual and anonymised registries from death certificates due to pneumonia for 1998-2015. Educational level data were gathered from microdata of the Colombian Demography Health Surveys. Rate ratios (RR) were estimated by using Poisson regression models, comparing mortality of educational groups with mortality in the highest education group. Relative index of inequality (RII) was measured to assess changes in disparities, regressing mortality on the midpoint of the cumulative distribution of education, thereby considering the size of each educational group.
For adults 25+ years, the risk of dying was significantly higher among lower educated. The RRs depict increased risks of dying comparing lower and highest education level, and this tendency was stronger in woman than in men (RR for primary education=2.34 (95% CI 2.32 to 2.36), RR for secondary education=1.77 (95% CI 1.75 to 1.78) versus RR for primary education=1.83 (95% CI 1.81 to 1.85), RR for secondary education=1.51 (95% CI 1.50 to 1.53)). According to age groups, young adults (25-44 years) showed the largest inequality in terms of educational level; RRs for pneumonia mortality regarding the tertiary educated groups show increased mortality in the lower and secondary educated, and these differences decreased with ages. RII in pneumonia mortality among adult men was 2.01 (95% CI 2.00 to 2.03) and in women 2.46 (95% CI 2.43 to 2.48). The RII was greatest at young ages, for both sexes. Time trends showed steadily significant increases for RII in both men and women (estimated annual percentage change (EAPC)men=3.8; EAPCwomen=2.6).
A significant increase on the educational inequalities in mortality due to pneumonia during all period was found among men and women. Efforts to reduce pneumonia mortality in adults improving population health by raising education levels should be strengthened with policies that assure widespread access to economic and social opportunities.
利用教育水平作为社会经济地位的代表，探讨哥伦比亚成年人肺炎死亡率相关的社会不平等现象的存在和趋势。
我们从 1998 年至 2015 年因肺炎死亡的死亡证明中获取了个人和匿名登记册。教育水平数据来自哥伦比亚人口与健康调查的微观数据。使用泊松回归模型估计率比（RR），将教育水平组的死亡率与最高教育水平组的死亡率进行比较。相对不平等指数（RII）用于衡量差异变化，死亡率回归到教育累积分布的中点，从而考虑每个教育水平组的规模。
对于 25 岁以上的成年人，受教育程度较低的人死亡风险明显更高。RR 描绘了与最低和最高教育水平相比，死亡风险增加，这种趋势在女性中比男性更强（小学教育 RR=2.34（95%CI 2.32 至 2.36），中学教育 RR=1.77（95%CI 1.75 至 1.78）与小学教育 RR=1.83（95%CI 1.81 至 1.85），中学教育 RR=1.51（95%CI 1.50 至 1.53））。按年龄组划分，年轻成年人（25-44 岁）的教育水平差异最大；肺炎死亡率与高等教育群体相关的 RR 显示，较低和中等教育水平的死亡率增加，这些差异随着年龄的增长而减小。成年男性肺炎死亡率的 RII 为 2.01（95%CI 2.00 至 2.03），女性为 2.46（95%CI 2.43 至 2.48）。对于两性来说，这种 RII 在年轻年龄段最大。时间趋势显示，男性和女性的 RII 均呈稳步显著上升（男性估计年百分比变化（EAPC）=3.8；女性 EAPC=2.6）。
发现男性和女性的肺炎死亡率在整个时期都存在显著增加的教育不平等现象。为了降低成年人的肺炎死亡率，提高人口健康水平，应加强努力，通过提高教育水平，制定确保广泛获得经济和社会机会的政策。
