一个平等主义的社会？2006-2016 年澳大利亚非传染性疾病导致的过早死亡率不平等加剧。

An egalitarian society? Widening inequalities in premature mortality from non-communicable diseases in Australia, 2006-16.

机构信息

Global Burden of Disease Group, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.

出版信息

Int J Epidemiol. 2021 Jul 9;50(3):783-796. doi: 10.1093/ije/dyaa226.

DOI:10.1093/ije/dyaa226

PMID:33349872

Abstract

BACKGROUND

The recent slowdown in life expectancy increase in Australia has occurred concurrently with widening socioeconomic and geographical inequalities in all-cause mortality risk. We analysed whether, and to what extent, mortality inequalities among specific non-communicable diseases (NCDs) in Australia at ages 35-74 years widened during 2006-16.

METHODS

Registered deaths that occurred during 2006-16 in Australia were analysed. Inequalities were measured by area socioeconomic quintile [ranging from Q1 (lowest) to Q5 (highest)] and remoteness (major cities, inner regional, outer regional/remote/very remote). Age-standardized death rates (ASDR) for 35-74 years were calculated and smoothed over time.

RESULTS

NCD mortality inequalities by area socioeconomic quintile widened; the ratio of Q1 to Q5 ASDR for males increased from 1.96 [95% confidence interval (CI) 1.91-2.01] in 2011 to 2.08 (2.03-2.13) in 2016, and for females from 1.78 (1.73-1.84) to 1.96 (1.90-2.02). Moreover, Q1 NCD ASDRs did not clearly decline from 2011 to 2016. CVD mortality inequalities were wider than for all NCDs. There were particularly large increases in smoking-related mortality inequalities. In 2016, mortality inequalities were especially high for chronic respiratory diseases, alcohol-related causes and diabetes. NCD mortality rates outside major cities were higher than within major cities, and these differences widened during 2006-16. Higher mortality rates in inner regional areas than in major cities were explained by socioeconomic factors.

CONCLUSIONS

Widening of inequalities in premature mortality rates is a major public health issue in Australia in the context of slowing mortality decline. Inequalities are partly explained by major risk factors for CVDs and NCDs: being overweight or obese, lack of exercise, poor diet and smoking. There is a need for urgent policy responses that consider socioeconomic disadvantage.

摘要

背景

最近，澳大利亚的预期寿命增长放缓，同时，全因死亡率的社会经济和地理不平等也在扩大。我们分析了在 2006-16 年期间，澳大利亚 35-74 岁人群中特定非传染性疾病（NCD）的死亡率不平等是否以及在多大程度上扩大。

方法

分析了 2006-16 年期间澳大利亚的注册死亡人数。不平等程度通过地区社会经济五分位数（范围从 Q1（最低）到 Q5（最高））和偏远程度（主要城市、内部区域、外部区域/偏远/非常偏远）来衡量。计算了 35-74 岁的年龄标准化死亡率（ASDR），并随时间进行了平滑处理。

结果

NCD 死亡率的地区社会经济五分位数不平等扩大；男性的 Q1 与 Q5 ASDR 之比从 2011 年的 1.96（95%置信区间（CI）1.91-2.01）增加到 2016 年的 2.08（2.03-2.13），女性从 1.78（1.73-1.84）增加到 1.96（1.90-2.02）。此外，Q1 NCD ASDR 并未从 2011 年到 2016 年明显下降。CVD 死亡率不平等大于所有 NCD。与吸烟相关的死亡率不平等增加尤为明显。2016 年，慢性呼吸道疾病、酒精相关原因和糖尿病的死亡率不平等尤其高。主要城市以外的 NCD 死亡率高于主要城市，并且在 2006-16 年期间差距扩大。与主要城市相比，内陆地区的死亡率更高，这是由社会经济因素造成的。