McMinn Megan A, Seaman Rosie, Dundas Ruth, Pell Jill P, Leyland Alastair H
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Usher Institute, University of Edinburgh, Edinburgh,UK.
Popul Space Place. 2020 Sep 22;28(3). doi: 10.1002/psp.2385. eCollection 2022 Apr.
Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.
在整个欧洲，可避免死亡率方面的社会经济不平等正在加剧，这对全民医疗体系构成了挑战，因为在全民医疗体系中，可避免死亡的数量及不平等程度应随着时间的推移保持在最低水平并呈下降趋势。然而，根本原因理论认为，在可预防的病因方面，健康不平等现象最为严重，因为资源分配不均会被用来获取优势。关于可能更好地反映根本原因的个体层面不平等的信息仍然有限。我们利用苏格兰纵向研究，追踪至2010年，通过一系列社会经济地位指标来研究可避免死亡率的趋势。研究发现，所有社会经济地位指标都存在巨大的不平等，其中教育程度方面的不平等最低，社会阶层方面的不平等较高，社会联系方面的不平等最高。为了减少不平等现象，可避免死亡率既需要被视为医疗质量的一个指标，也需要被视为社会经济资源分配不平等的一种反映。
