Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
Popul Health Metr. 2021 Oct 20;19(1):40. doi: 10.1186/s12963-021-00271-2.
In many high-income countries, life expectancy (LE) has increased, with women outliving men. This gender gap in LE (GGLE) has been explained with biological factors, healthy behaviours, health status, and sociodemographic characteristics, but little attention has been paid to the role of public health policies that include/affect these factors. This study aimed to assess the contributions of avoidable causes of death, as a measure of public health policies and healthcare quality impacts, to the GGLE and its temporal changes in the UK. We also estimated the contributions of avoidable causes of death into the gap in LE between countries in the UK.
We obtained annual data on underlying causes of death by age and sex from the World Health Organization mortality database for the periods 2001-2003 and 2014-2016. We calculated LE at birth using abridged life tables. We applied Arriaga's decomposition method to compute the age- and cause-specific contributions into the GGLE in each period and its changes between two periods as well as the cross-country gap in LE in the 2014-2016 period.
Avoidable causes had greater contributions than non-avoidable causes to the GGLE in both periods (62% in 2001-2003 and 54% in 2014-2016) in the UK. Among avoidable causes, ischaemic heart disease (IHD) followed by injuries had the greatest contributions to the GGLE in both periods. On average, the GGLE across the UK narrowed by about 1.0 year between 2001-2003 and 2014-2016 and three avoidable causes of IHD, lung cancer, and injuries accounted for about 0.8 years of this reduction. England & Wales had the greatest LE for both sexes in 2014-2016. Among avoidable causes, injuries in men and lung cancer in women had the largest contributions to the LE advantage in England & Wales compared to Northern Ireland, while drug-related deaths compared to Scotland in both sexes.
With avoidable causes, particularly preventable deaths, substantially contributing to the gender and cross-country gaps in LE, our results suggest the need for behavioural changes by implementing targeted public health programmes, particularly targeting younger men from Scotland and Northern Ireland.
在许多高收入国家，预期寿命（LE）有所增加，女性的寿命超过男性。这种 LE 性别差距（GGLE）可以用生物学因素、健康行为、健康状况和社会人口特征来解释，但很少有人关注包括/影响这些因素的公共卫生政策的作用。本研究旨在评估可避免死因作为公共卫生政策和医疗保健质量影响的衡量标准，对英国 GGLE 及其时间变化的贡献。我们还估计了可避免死因对英国各国 LE 差距的贡献。
我们从世界卫生组织死亡率数据库中获得了 2001-2003 年和 2014-2016 年期间按年龄和性别分列的死因的年度数据。我们使用简化生命表计算了出生时的 LE。我们应用 Arriaga 的分解方法来计算每个时期 GGLE 的年龄和死因特异性贡献以及两个时期之间的变化，以及 2014-2016 年期间的国家间 LE 差距。
在两个时期（2001-2003 年为 62%，2014-2016 年为 54%），可避免死因对 GGLE 的贡献均大于不可避免死因。在可避免死因中，缺血性心脏病（IHD）其次是损伤对 GGLE 的贡献最大。平均而言，英国的 GGLE 在 2001-2003 年至 2014-2016 年间缩小了约 1.0 年，而 IHD、肺癌和损伤这三个可避免死因约占这一减少的 0.8 年。英格兰和威尔士在 2014-2016 年为两性提供了最长的 LE。在可避免死因中，与北爱尔兰相比，男性的损伤和女性的肺癌对英格兰和威尔士 LE 优势的贡献最大，而两性的药物相关死亡与苏格兰相比。
由于可避免死因，特别是可预防的死亡，对 LE 的性别和国家间差距有很大贡献，我们的研究结果表明需要通过实施有针对性的公共卫生计划来改变行为，特别是针对苏格兰和北爱尔兰的年轻男性。
