Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway; Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Department of Health and Society, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway.
Lancet Public Health. 2022 Jul;7(7):e593-e605. doi: 10.1016/S2468-2667(22)00092-5.
Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties.
Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient.
Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors.
Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.
Bill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health.
许多国家都报告了健康结果的地域差异。自 20 世纪 70 年代以来，挪威一直积极推行旨在实现地区平衡的政策。我们利用 2019 年全球疾病负担研究（GBD）的数据，研究了挪威各郡在发展和当前健康状况方面的地域差异。
从 2019 年 GBD 中提取了挪威及其 11 个郡从 1990 年到 2019 年的预期寿命、健康预期寿命（HALE）、生命损失年（YLLs）、伤残生命年（YLDs）和伤残调整生命年（DALYs）的数据。比较了各县预期寿命变化的具体贡献。使用基尼系数检查疾病负担的不平等情况。
从 1990 年到 2019 年，挪威所有郡的预期寿命和 HALE 都有所提高。在 1990 年预期寿命和 HALE 值最低的两个郡中，预期寿命和 HALE 的改善最大：奥斯陆，其预期寿命和 HALE 分别从 1990 年的 71.9 岁（95%不确定区间 71.4-72.4）和 63.0 岁（60.5-65.4）增加到 2019 年的 81.3 岁（80.0-82.7）和 70.6 岁（67.4-73.6）；特罗姆瑟和芬马克，其预期寿命和 HALE 分别从 1990 年的 71.9 岁（71.5-72.4）和 63.5 岁（60.9-65.6）增加到 2019 年的 80.3 岁（79.4-81.2）和 70.0 岁（66.8-72.2）。预期寿命的增加主要归因于心血管疾病、肿瘤和呼吸道感染的减少。2019 年，在任何一个郡都没有报告国家 YLD 或 DALY 率与相应的年龄标准化率之间存在显著差异；然而，特罗姆瑟和芬马克的年龄标准化 YLL 率高于全国水平（每 10 万人 8394 人[95%置信区间 7801-8944]比每 10 万人 7536 人[7391-7691]）。各县的预期寿命、HALE、所有一级 DALY 病因以及一级风险因素暴露的差异均显示出低不平等。
在过去的 30 年里，挪威已经减少了各县之间疾病负担的不平等。然而，在县内一级以及其他社会人口学梯度上，仍存在不平等现象。由于挪威的初级数据不足，非致命性疾病负担和风险因素暴露的区域估计仍存在很大的不确定性。
比尔及梅琳达·盖茨基金会、挪威研究理事会和挪威公共卫生研究所。
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