State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
Public Health. 2021 Jul;196:158-164. doi: 10.1016/j.puhe.2021.04.034. Epub 2021 Jul 3.
It is important to understand the factors that can substantially decrease mortality rates, as multiple strategies have been implemented to improve economic development and national health in China. We aimed to describe the geographic variations and changes in the all-cause mortality rates in 2005-2015 and to investigate the social factors that tend to decline age-standardized all-cause mortality rates.
Ecological study.
The data used came from China's National Census Survey in 2005, 2010 and 2015 and China National Statistical Yearbooks. We conducted provincial-level thematic mapping of age-standardized all-cause mortality rate trajectory groups in 2005-2015 by using ArcGIS. Generalized estimating equation (GEE) models were used to clarify the social factors that may have long-term relevance to declining age-standardized all-cause mortality rates. We compared the characteristics of the three provinces with the lowest mortality rates and the three provinces with the highest mortality rates to further understand the health disparities.
The age-standardized mortality rates declined from 2000 to 2006 and from 2008 to 2019. Provinces in the low-trajectory tended to be located in the Northeast and Southeast China. The GEE results revealed that the greater the proportion of the population with senior high school education or above, the more families with flushing or pumping toilets that are not shared with other households, the more nurses per 1000 people and a stable economic growth rate were inclined to low age-standardized all-cause mortality rates (P < 0.05).
Health disparities between different regions were still in existence even in 2015. Thus, it is critical to improve equality in economic and educational development, the distribution of healthcare professionals, and sanitation facilities, to ensure the equality of opportunities in terms of healthy lives and well-being for all. Furthermore, for developing countries, the improvement of national health urgently needs to prevent the health risks relevant to rapid industrialization and urbanization.
了解能够显著降低死亡率的因素非常重要，因为中国已经实施了多种策略来促进经济发展和提高国民健康水平。本研究旨在描述 2005-2015 年全因死亡率的地域差异和变化，并探讨趋于降低年龄标准化全因死亡率的社会因素。
生态学研究。
本研究使用的数据来自于 2005 年、2010 年和 2015 年的中国全国人口普查以及《中国国家统计年鉴》。我们利用 ArcGIS 对 2005-2015 年省级年龄标准化全因死亡率轨迹组进行主题地图绘制。使用广义估计方程（GEE）模型来阐明与年龄标准化全因死亡率长期相关的社会因素。我们比较了死亡率最低的三个省份和死亡率最高的三个省份的特征，以进一步了解健康差异。
年龄标准化死亡率从 2000 年至 2006 年以及 2008 年至 2019 年呈下降趋势。处于低轨迹的省份多位于中国东北和东南地区。GEE 结果表明，高中及以上受教育程度人口比例越高、拥有独立冲洗或抽水马桶的家庭越多、每 1000 人护士越多、经济增长率越稳定，越倾向于低年龄标准化全因死亡率（P<0.05）。
即使在 2015 年，不同地区之间的健康差异仍然存在。因此，改善经济和教育发展、卫生保健专业人员分布和卫生设施的平等性至关重要，以确保所有人在健康生活和福祉方面都有平等的机会。此外，对于发展中国家而言，提高国民健康水平迫切需要预防与快速工业化和城市化相关的健康风险。
