Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
BMJ Open. 2022 Mar 30;12(3):e054507. doi: 10.1136/bmjopen-2021-054507.
We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30-64, 65-79 and 80+ years).
Repeated cross-sectional design using Swedish total population register data.
All persons aged 30 years and older living in Sweden 1995-1996, 2005-2006 and 2016-2017 (n=8 084 620).
Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group.
From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30-64 years and 65-79 years. Absolute inequalities increased in the age group 65-79 years. Among persons aged 80+ years, inequalities were small. The shape of the income-mortality association was curvilinear in the age group 30-64 years; the gradient was stronger below the fourth percentile. In the age group 65-79 years, the shape shifted from linear in 1995-1996 to a more curvilinear shape in 2016-2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017.
The continued increase of relative (ages 30-79 years) and absolute (ages 65-79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.
我们研究了瑞典近期死亡率收入不平等的趋势及其关联形态。我们考虑了三个年龄组（30-64 岁、65-79 岁和 80 岁以上）的全因、可预防和不可预防死亡率。
使用瑞典总人口登记数据进行重复横断面设计。
1995-1996 年、2005-2006 年和 2016-2017 年居住在瑞典的所有 30 岁及以上人群（n=8084620）。
按收入十分位数和年龄组计算全因、可预防和不可预防死亡率的率差异和率比。
1995 年至 2017 年期间，瑞典 30-64 岁和 65-79 岁年龄组的死亡率收入不平等程度相对增加。65-79 岁年龄组的绝对不平等程度增加。80 岁以上人群的不平等程度较小。30-64 岁年龄组的收入-死亡率关联呈曲线形；低于第四百分位数时梯度更强。在 65-79 岁年龄组，形状从 1995-1996 年的线性转变为 2016-2017 年的更曲线形。在最年长的年龄组（80 岁以上），观察到了不同的形状。与不可预防死亡率相比，可预防死亡率的不平等程度更为明显。1995 年至 2017 年期间，可预防和不可预防死亡率的收入不平等程度以相似的速度增加。
瑞典相对（30-79 岁）和绝对（65-79 岁）死亡率不平等的持续增加应成为公共卫生政策的首要关注点。可预防和不可预防死亡率不平等程度的均匀增加表明，导致健康不平等加剧的解释模型比单纯的社会因果关系更为复杂。
