MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK.
Int J Equity Health. 2020 Dec 4;19(1):215. doi: 10.1186/s12939-020-01329-7.
Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as "deaths of despair", they are seen to stem from unprecedented economic pressures and a breakdown in social support structures.
We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15-44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RII) for the years 2001-2018.
Since 1980 there have been only small reductions in mortality among men aged 15-44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7-1.4) to 44.9 (95% CI 42.5-47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5-70.9) in 2001-2003 to SII = 120.0 (95% CI 113.3-126.8) in 2016-2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality.
Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.
在许多国家，男性因药物、酒精和自杀导致的死亡率上升是一个日益严重的公共卫生问题。这些死亡被统称为“绝望致死”，它们被认为源于前所未有的经济压力和社会支持结构的崩溃。
我们使用高质量的全苏格兰数据，计算了 1980 年至 2018 年期间 15 种主要死因导致的 15-44 岁男性的年龄标准化死亡率。通过小面积贫困和 2001-2018 年的斜率和相对不平等指数（SII 和 RII），计算了死因导致的死亡率的绝对和相对不平等。
自 1980 年以来，苏格兰 15-44 岁男性的死亡率仅略有下降。在此期间，与药物相关的死亡人数从每 10 万人 1.2（95%CI 0.7-1.4）增加到 44.9（95%CI 42.5-47.4），现已成为主要死因。2001 年至 2018 年，全因死亡率的绝对不平等有所减少，但相对不平等没有减少。然而，药物导致的死亡率的绝对不平等从 2001-2003 年的 SII=66.6（95%CI 61.5-70.9）增加到 2016-2018 年的 SII=120.0（95%CI 113.3-126.8），增加了一倍。药物是导致死亡率不平等的主要因素，与酒精危害和自杀一起，占死亡率绝对不平等的 65%。
与过去几十年所有年龄段死亡率大幅下降形成鲜明对比的是，年轻男性的死亡率正在因可预防的原因而上升。减少外部原因导致的死亡率的努力仅集中在单一死因上，并且在长期内并没有有效降低外部原因导致的死亡率或死亡率不平等。为了减少“绝望致死”，应采取行动解决健康的社会决定因素，减少社会经济不平等。
