Holmager Therese L F, Thygesen Lars, Buur Lene T, Lynge Elsebeth
Centre for Epidemiological Research, Nykøbing Falster Hospital, University of Copenhagen, Ejegodvej 63, DK-4800 Nykøbing Falster, Copenhagen, Denmark.
Thygesen Statistics Consulting, Copenhagen, Denmark.
BMC Public Health. 2021 Jan 7;21(1):90. doi: 10.1186/s12889-020-10108-6.
Lolland-Falster is a rural area of Denmark, where the life expectancy is presently almost six years lower than in the rich capital suburbs. To determine the origin of this disparity, we analysed changes in mortality during 50 years in Lolland-Falster.
Annual population number and number of deaths at municipality level were retrieved from StatBank Denmark and from Statistics Denmark publications, 1968-2017. For 1974-2017, life expectancy at birth by sex and 5-year calendar period was calculated. From 1968 to 2017, standardised mortality ratio (SMR) for all-cause mortality was calculated by sex, 5-year calendar period and municipality, with Denmark as standard and including 95% confidence intervals (CI).
In 1968-2017, life expectancy in Lolland-Falster increased, but less so than in the rest of Denmark. Fifty years ago, Lolland-Falster had a mortality similar to the rest of Denmark. The increasing mortality disparity developed gradually starting in the late 1980s, earlier in Lolland municipality (western part) than in Guldborgsund municipality (eastern part), and earlier for men than for women. By 2013-2017, the SMR had reached 1.25 (95% CI 1.19-1.31) for men in the western part, and 1.11 (95% CI 1.08-1.16) for women in the eastern part. Increasing mortality disparity was particularly seen in people aged 20-69 years.
This study is the first to report on increasing geographical segregation in all-cause mortality in a Nordic welfare state. Development of the mortality disparity between Lolland-Falster and the rest of Denmark followed changes in agriculture, industrial company closure, a shipyard close-down, administrative centralisation, and a decreasing population size.
洛兰 - 法尔斯特是丹麦的一个农村地区，目前该地区的预期寿命比富裕的首都郊区低近6年。为了确定这种差异的根源，我们分析了洛兰 - 法尔斯特50年来的死亡率变化情况。
1968年至2017年，从丹麦统计局数据库和丹麦统计局出版物中获取市级层面的年度人口数量和死亡人数。计算1974年至2017年按性别和5年日历期划分的出生时预期寿命。1968年至2017年，以丹麦为标准，计算按性别、5年日历期和市划分的全因死亡率标准化死亡率（SMR），并包括95%置信区间（CI）。
1968年至2017年，洛兰 - 法尔斯特的预期寿命有所增加，但增幅低于丹麦其他地区。50年前，洛兰 - 法尔斯特的死亡率与丹麦其他地区相近。从20世纪80年代末开始，死亡率差异逐渐增大，洛兰市（西部）比古尔堡松市（东部）更早出现，男性比女性更早出现。到2013年至2017年，西部男性的SMR达到1.25（95%CI 1.19 - 1.31），东部女性的SMR达到1.11（95%CI 1.08 - 1.16）。死亡率差异增加在20至69岁人群中尤为明显。
本研究首次报告了北欧福利国家全因死亡率地理隔离加剧的情况。洛兰 - 法尔斯特与丹麦其他地区之间死亡率差异的发展与农业变化、工业公司关闭、造船厂倒闭、行政集中化以及人口规模减少有关。
