Di Girolamo Chiara, Caranci Nicola, Giorgi Rossi Paolo, Pandolfi Paolo, Carrozzi Giuliano, Moro Maria Luisa, Pacelli Barbara
Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna;
Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna.
Epidemiol Prev. 2020 Sep-Dec;44(5-6):349-358. doi: 10.19191/EP20.5-6.P349.010.
to describe changes in relative and absolute inequalities in mortality by education level between 2001 and 2016 in the Emilian longitudinal study (SLEm) and to estimate the impact of these inequalities at population level.
closed cohort study based on record-linkage between municipal population registries, Census archives of 2001 and 2011, and the mortality register.
2001- and 2011-Census respondents >=30 years old residing in Bologna, Modena, or Reggio Emilia followed up to the age of 75 years, death, emigration, or end of follow-up (December 2006 or December 2016).
premature mortality for all causes and for 16 groups of causes known to be associated with socioeconomic position. In order to capture various aspects of the inequalities, the association with the education level is assessed through summary regression-based indexes (Relative and Slope Index of Inequality) and the Attributable Population Fraction.
premature mortality declined across all educational level between 2001-2006 and 2011-2016; declines were greater among men than women. Among men, relative inequalities in mortality slightly increased (RII from 1.86 in 2001 to 2.13 in 2011), while absolute inequalities declined (SII from 382.3 to 360.6). Among women, both relative and absolute inequalities increased (RII from 1.23 to 1.65, SII from 73.7 to 137.4). Educational inequalities in lung cancer, respiratory and cerebrovascular diseases mortality decreased among men and increased among women. The proportion of the low educated shrank over time (men: from 40% to 36%; women: from 43% to 35%); nonetheless, the fraction of the deaths attributable to educational inequalities showed an upward tendency (from 18.5% to 21.9% in men and from 9.7% to 15.6% in women); the groups of causes that contribute most to this increase were malignant cancers, especially lung cancer, diseases of the circulatory and respiratory systems, and accidents.
relative inequalities slightly increased in both genders, while absolute inequalities only in women. A reduction in the population impact could be achieved by tackling educational inequalities in mortality due to lung cancer, diseases of the circulatory and respiratory systems, and accidents.
描述艾米利亚纵向研究（SLEm）中2001年至2016年间按教育水平划分的死亡率相对和绝对不平等的变化，并估计这些不平等在人群层面的影响。
基于市政人口登记册、2001年和2011年人口普查档案以及死亡率登记册之间的记录链接进行的封闭队列研究。
2001年和2011年人口普查中年龄≥30岁、居住在博洛尼亚、摩德纳或雷焦艾米利亚的受访者，随访至75岁、死亡、移民或随访结束（2006年12月或2016年12月）。
所有原因以及已知与社会经济地位相关的16组原因导致的过早死亡。为了捕捉不平等的各个方面，通过基于汇总回归的指数（不平等相对指数和斜率指数）以及归因人口比例来评估与教育水平的关联。
2001 - 2006年至2011 - 2016年期间，所有教育水平的过早死亡率均下降；男性下降幅度大于女性。在男性中，死亡率的相对不平等略有增加（不平等相对指数从2001年的1.86增至2011年的2.13），而绝对不平等下降（不平等斜率指数从382.3降至360.6）。在女性中，相对和绝对不平等均增加（不平等相对指数从1.23增至1.65，不平等斜率指数从73.7增至137.4）。男性肺癌、呼吸系统和脑血管疾病死亡率的教育不平等下降，女性则增加。低教育水平人群的比例随时间减少（男性：从40%降至36%；女性：从43%降至35%）；尽管如此，归因于教育不平等的死亡比例呈上升趋势（男性从18.5%升至21.9%，女性从9.7%升至15.6%）；导致这一增长的主要原因组是恶性肿瘤，尤其是肺癌、循环系统和呼吸系统疾病以及事故。
两性的相对不平等略有增加，而绝对不平等仅在女性中增加。通过解决肺癌、循环系统和呼吸系统疾病以及事故导致的死亡率方面的教育不平等问题，可以减少对人群的影响。
