澳大利亚按教育程度划分的预期寿命不平等：全人群记录链接研究。
Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study.
机构信息
Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia.
School of Demography, Australian National University, Acton, Australia.
出版信息
Int J Equity Health. 2021 Aug 3;20(1):178. doi: 10.1186/s12939-021-01513-3.
BACKGROUND
Life expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. To monitor socioeconomic inequalities in health, many high-income countries routinely report life expectancy by education level. However in Australia, education-related gaps in life expectancy are not routinely reported because, until recently, the data required to produce these estimates have not been available. Using newly linked, whole-of-population data, we estimated education-related inequalities in adult life expectancy in Australia.
METHODS
Using data from 2016 Australian Census linked to 2016-17 Death Registrations, we estimated age-sex-education-specific mortality rates and used standard life table methodology to calculate life expectancy. For men and women separately, we estimated absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years according to education level (measured in five categories, from university qualification [highest] to no formal qualifications [lowest]).
RESULTS
Data came from 14,565,910 Australian residents aged 25 years and older. At each age, those with lower levels of education had lower life expectancies. For men, the gap (highest vs. lowest level of education) was 9.1 (95 %CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. For women, the gap was 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences (comparing highest education level with each of the other levels) were larger for men than women and increased with age, but overall, revealed a 10-25 % reduction in life expectancy for those with the lowest compared to the highest education level.
CONCLUSIONS
Education-related inequalities in life expectancy from age 25 years in Australia are substantial, particularly for men. Those with the lowest education level have a life expectancy equivalent to the national average 15-20 years ago. These vast gaps indicate large potential for further gains in life expectancy at the national level and continuing opportunities to improve health equity.
背景
澳大利亚的预期寿命在全球范围内名列前茅，但国家估计数据掩盖了国内的不平等现象。为了监测健康方面的社会经济不平等，许多高收入国家通常会按教育程度报告预期寿命。然而，在澳大利亚，由于直到最近才获得用于编制这些估计数的数据，因此通常不报告与教育相关的预期寿命差距。我们利用新的全人群关联数据，估计了澳大利亚成年人预期寿命的教育相关不平等。
方法
我们使用 2016 年澳大利亚人口普查与 2016-17 年死亡登记的关联数据，估计了按年龄、性别和教育程度划分的特定死亡率，并使用标准生命表方法计算了预期寿命。我们分别为男性和女性估计了按教育程度（分为五个类别，从大学学历[最高]到无正式学历[最低]）划分的 25 岁、45 岁、65 岁和 85 岁的预期寿命的绝对（以年为单位）和相对（比值）差异。
结果
数据来自于 14565910 名年龄在 25 岁及以上的澳大利亚居民。在每个年龄组中，受教育程度较低的人的预期寿命较低。在男性中，25 岁时的差距（最高和最低教育程度）为 9.1 年（95%CI：8.8，9.4），45 岁时为 7.3 年（7.1，7.5），65 岁时为 4.9 年（4.7，5.1），85 岁时为 1.9 年（1.8，2.1）。在女性中，25 岁时的差距为 5.5 年（5.1，5.9），45 岁时为 4.7 年（4.4，5.0），65 岁时为 3.3 年（3.1，3.5），85 岁时为 1.6 年（1.4，1.8）。男性的相对差异（比较最高教育程度与其他每个教育程度）大于女性，且随着年龄的增长而增加，但总体而言，与最高教育程度相比，最低教育程度的预期寿命减少了 10-25%。
结论
澳大利亚从 25 岁开始的预期寿命与教育相关的不平等现象相当严重，尤其是对男性而言。受教育程度最低的人的预期寿命相当于全国平均水平 15-20 年前的水平。这些巨大差距表明，在国家层面上进一步提高预期寿命和继续改善健康公平方面仍有很大的潜力。
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