Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Int J Environ Res Public Health. 2021 Jul 2;18(13):7091. doi: 10.3390/ijerph18137091.
Geographical inequalities in premature mortality and the role of neighbourhood social determinants of health (SDOH) have been less explored. This study aims to assess the geographical inequalities in premature mortality in Taiwan and how neighbourhood SDOH contribute to them and to examine the place-specific associations between neighbourhood SDOH and premature mortality. We used township-level nationwide data for the years 2015 to 2019, including age-standardized premature mortality rates and three upstream SDOH (ethnicity, education, and income). Space-time scan statistics were used to assess the geographical inequality in premature mortality. A geographical and temporal weighted regression was applied to assess spatial heterogeneity and how neighbourhood SDOH contribute to geographic variation in premature mortality. We found geographical inequality in premature mortality to be clearly clustered around mountainous rural and indigenous areas. The association between neighbourhood SDOH and premature mortality was shown to be area-specific. Ethnicity and education could explain nearly 84% variation in premature mortality. After adjusting for neighbourhood SDOH, only a handful of hotspots for premature mortality remained, mainly consisting of rural and indigenous areas in the central-south region of Taiwan. These findings provide empirical evidence for developing locally tailored public health programs for geographical priority areas.
地理上的过早死亡率不平等以及邻里健康社会决定因素（SDOH）的作用尚未得到充分探讨。本研究旨在评估台湾地区过早死亡率的地理不平等现象，以及邻里 SDOH 如何导致这些不平等，并研究邻里 SDOH 与过早死亡率之间的特定地点关联。我们使用了 2015 年至 2019 年的乡镇级全国数据，包括年龄标准化的过早死亡率和三个上游 SDOH（族裔、教育和收入）。时空扫描统计数据用于评估过早死亡率的地理不平等。应用地理和时间加权回归来评估邻里 SDOH 对过早死亡率地理变异的空间异质性和贡献。我们发现，过早死亡率的地理不平等现象明显集中在山区农村和原住民地区。邻里 SDOH 与过早死亡率之间的关联具有区域特异性。族裔和教育可以解释近 84%的过早死亡率变化。在调整了邻里 SDOH 后，仅剩下少数几个过早死亡率的热点地区，主要集中在台湾中南部的农村和原住民地区。这些发现为制定针对地理优先地区的量身定制的公共卫生计划提供了经验证据。
