Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
Eur J Public Health. 2021 Jul 13;31(3):527-533. doi: 10.1093/eurpub/ckaa194.
Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father's manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption.
We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010-14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated ('upward levelling scenario'), using Population Attributable Fractions.
Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father's manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small.
Disadvantages in material circumstances (low income), circumstances during childhood (father's manual occupation) and high body-weight contribute to inequalities in years with disability.
尽管社会经济地位较低的人群预期寿命较短，但他们在残疾期间所花费的时间却更多，但其重要决定因素尚不清楚。本研究旨在量化 8 种风险因素（父亲从事体力劳动、收入低、社交联系少、吸烟、酗酒、体重高、身体活动少、水果和蔬菜摄入少）对残疾年数方面教育不平等的贡献。
我们收集了来自 15 个欧洲国家的基于登记的死亡率和基于调查的残疾和风险因素数据，这些国家大多数都覆盖了 2010-14 年期间的数据。我们使用 Sullivan 方法，根据教育和性别计算了 35-80 岁之间的残疾年数，并通过人群归因分数确定了将每种风险因素的流行率更改为高教育人群（向上调整情景）的假设效果。
低教育人群的残疾年数高于高教育人群，所有国家的男性差异为 4.9 年，女性差异为 5.5 年。大多数风险因素在低教育人群中更为普遍。我们发现，对残疾年数不平等的最大贡献来自低收入（男性：1.0 年；女性：1.4 年）、高体重（男性：0.6 年；女性：1.2 年）和父亲从事体力劳动（男性：0.7 年；女性：0.9 年），但各国之间存在差异。吸烟的贡献相对较小。
物质条件（低收入）、儿童时期的环境（父亲从事体力劳动）和体重高是导致残疾年数不平等的原因。
