Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Front Public Health. 2022 Jun 15;10:797379. doi: 10.3389/fpubh.2022.797379. eCollection 2022.
Deaths due to medical care appear common. Individuals with low socioeconomic position seem to be at a higher risk for sustaining a medical adverse event and premature death. This time series analysis aimed to assess educational gradients behind adverse event deaths in the US over the period 2010-2019.
Publicly available mortality and census data were retrieved from official sources. The data included age, sex, educational attainment, and underlying cause of death. Adverse event deaths were identified by ICD-10 codes Y40-Y84 and Y88. Four education categories were created in accordance with the International Standard Classification of Education 2011 coding scheme [No high school or General Educational Development (GED); High school or GED; Some college; Bachelor's degeree or higher]. To capture also highly educated individuals, the analysis was delimited to ≥30-year-olds. Age-adjusted mortality rates (AMRs) were compared between education categories by means of mortality plots and linear mixed models.
A total of 25,897,334 certified deaths occurred among ≥30-year-olds during the study period. The underlying cause of death was an adverse event in a rarity of cases (0.12%, = 31,997). Individuals with Bachelor's degeree or higher had the lowest adverse event AMRs (6.1-12.4 per million per year), followed by the Some college category (9.6-18.6), the High school or GED category (17.1-35.4), and finally the No high school or GED category (20.0-36.0). AMRs showed a gradual increase as education level decreased ( ≤ 0.001 against those with Bachelor's degeree or higher). Moreover, the temporal increase in adverse event AMRs was more pronounced among individuals with low than high education; the contrasts between categories were greatest toward the end of the study period.
The findings of this study suggest that the widening socioeconomic gradients in mortality extend also to fatal adverse events. Future studies should aim to analyze whether access to care, severity of the condition at presentation, quality of care, and social determinants of health may drive the gradients.
医疗保健导致的死亡似乎很常见。社会经济地位较低的人似乎更容易发生医疗不良事件和过早死亡。本时间序列分析旨在评估 2010-2019 年期间美国不良事件死亡背后的教育梯度。
从官方来源检索了公开的死亡率和人口普查数据。这些数据包括年龄、性别、教育程度和根本死因。通过 ICD-10 编码 Y40-Y84 和 Y88 确定不良事件死亡。根据 2011 年国际教育标准分类编码方案，创建了四个教育类别[无高中学历或普通教育发展 (GED)；高中学历或 GED；一些大学；学士学位或更高]。为了还包括高学历人群，分析仅限于≥30 岁的人群。通过死亡率图和线性混合模型比较了不同教育类别的年龄调整死亡率 (AMR)。
在研究期间，共有 25897334 名≥30 岁的人被证实死亡。罕见情况下，死亡原因为不良事件 (0.12%，=31997)。拥有学士学位或更高学历的人不良事件 AMR 最低 (6.1-12.4 每百万每年)，其次是一些大学类别 (9.6-18.6)、高中学历或 GED 类别 (17.1-35.4)，最后是无高中学历或 GED 类别 (20.0-36.0)。随着教育水平的降低，AMR 逐渐升高 (与拥有学士学位或更高学历者相比， ≤ 0.001)。此外，在低教育水平人群中，不良事件 AMR 的时间增长更为明显；在研究期末，类别之间的差异最大。
本研究结果表明，死亡率的社会经济梯度扩大也延伸到致命的不良事件。未来的研究应旨在分析是否可以通过获得医疗服务、就诊时病情的严重程度、医疗质量和健康的社会决定因素来解释这些梯度。
