Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Bioethics, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Public Health. 2021 Nov;200:99-105. doi: 10.1016/j.puhe.2021.09.022. Epub 2021 Oct 26.
The aim of this study was to analyze inequalities of amenable mortality by place of residence and its changes in Lithuania during 1990-2019.
A record-linked cohort study.
Information on deaths was obtained from Statistics Lithuania and the Institute of Hygiene. Mortality rates from amenable causes of death by urban and rural among men and women were calculated per 100,000 population and were standardized by age. Inequalities in mortality were assessed using rate differences. For the assessment of the trends of mortality and its inequalities during 1990-2019, joinpoint regression analysis was applied.
During 1990-2019, amenable mortality of men and women in rural areas was higher compared to urban areas (P < 0.05). Changes in men's and women's mortality and its inequalities between rural and urban areas were characterized by three cut-off points (P < 0.05). However, not all the periods between the cut-off points were characterized by statistically significant changes in mortality. A reduction in amenable mortality was more evident in women, especially those living in rural areas. During 1990-2004 and in 2006, the differences in amenable mortality were greater among rural and urban women than among men. However, during 2013-2019, the differences were smaller (P < 0.05). Inequalities of men's mortality decreased during 1990-2001 and 2005-2012, and inequalities of women's mortality decreased during 1993-2006, 2006-2017, and 2017-2019 (P < 0.05). Inequalities of men's mortality decreased most rapidly during 2005-2012 (on average, by 10.24% per year), while inequalities of women's mortality decreased most rapidly during 2017-2019 (on average by 18.32% per year) (P < 0.05).
During 1990-2019, inequalities and a decline of inequalities in amenable mortality among rural and urban men and women were identified in Lithuania. The amenable mortality of the residents of Lithuania remained high, changed unevenly, and no significant sharp decrease was observed. Further reduction of inequalities in amenable mortality between rural and urban inhabitants with a special focus on men remain the health policy challenges in Lithuania.
本研究旨在分析立陶宛 1990-2019 年按居住地点划分的可避免死亡率的不平等及其变化。
一项基于记录的队列研究。
死亡信息来自立陶宛统计局和卫生研究所。按每 10 万人计算男女因可避免原因导致的死亡率，并按年龄标准化。使用率差异评估死亡率的不平等。应用 Joinpoint 回归分析评估 1990-2019 年死亡率及其不平等的趋势。
1990-2019 年，农村地区男性和女性的可避免死亡率均高于城市地区（P<0.05）。男性和女性死亡率及其城乡之间不平等的变化以三个截止点为特征（P<0.05）。然而，并非所有截止点之间的时期都表现出死亡率的统计学显著变化。可避免死亡率的下降在女性中更为明显，尤其是在农村地区。1990-2004 年和 2006 年，农村和城市女性之间的可避免死亡率差异大于男性。然而，2013-2019 年，差异较小（P<0.05）。1990-2001 年和 2005-2012 年男性死亡率的不平等程度下降，1993-2006 年、2006-2017 年和 2017-2019 年女性死亡率的不平等程度下降（P<0.05）。1990-2019 年，立陶宛农村和城市男性和女性的可避免死亡率不平等及其下降情况有所不同。立陶宛居民的可避免死亡率仍然很高，变化不均匀，且未观察到显著的大幅下降。进一步降低农村和城市居民之间可避免死亡率的不平等，特别是关注男性，仍然是立陶宛卫生政策面临的挑战。
