McMonagle Ciaran, Brown Denise, Reeve Richard, Mancy Rebecca
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK.
Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, Glasgow, UK.
SSM Popul Health. 2022 Aug 13;19:101192. doi: 10.1016/j.ssmph.2022.101192. eCollection 2022 Sep.
Previous research has demonstrated increasing diversity in causes of mortality among high-income nations in recent decades, associated with improvements in health and increasing life expectancies. Health outcomes are known to vary widely between communities within these countries and inequalities between sexes and other subpopulations are key in understanding the health of populations. Despite this, little is known about variation in the diversity of mortality causes between these subpopulations. Diversification in mortality causes indicates an increase in the pool of potential causes of mortality an individual is likely to face. This poses challenges for the public health and medical sectors by increasing diagnostic uncertainty and broadening the range of causes to be addressed by public health and medical interventions. Here we examine trends over time in the diversity in causes of mortality in Scotland by sex and area-level deprivation, also examining deaths among those younger than 75 years and those 75 years and older separately. We find that diversity in causes of mortality has increased across subpopulations; that it has risen more quickly in men than women; that the rate of increase has been similar across age categories; and that there is no clear ranking in the trends by deprivation quintile, despite slower improvements in mortality rates among the most deprived. Increasing diversity in mortality causes suggests that a greater public health focus on reducing death rates from a broader range of causes is likely to be required, and this may be especially important for men who face a faster rate of diversification.
以往的研究表明，近几十年来，高收入国家的死亡原因日益多样化，这与健康状况的改善和预期寿命的延长有关。众所周知，这些国家不同社区之间的健康结果差异很大，性别和其他亚人群之间的不平等是理解人群健康状况的关键。尽管如此，对于这些亚人群之间死亡原因多样性的差异却知之甚少。死亡原因的多样化表明个体可能面临的潜在死亡原因数量增加。这给公共卫生和医疗部门带来了挑战，因为诊断不确定性增加，公共卫生和医疗干预需要应对的原因范围也更广。在此，我们研究了苏格兰按性别和地区贫困程度划分的死亡原因多样性随时间的变化趋势，同时分别考察了75岁及以下人群和75岁及以上人群的死亡情况。我们发现，各亚人群的死亡原因多样性均有所增加；男性的增长速度快于女性；各年龄组的增长速度相似；尽管最贫困人群的死亡率改善较慢，但按贫困五分位数划分的趋势并没有明显的排名。死亡原因多样性的增加表明，可能需要公共卫生更加关注降低更广泛原因导致的死亡率，这对面临更快多样化速度的男性可能尤为重要。
