University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
Public Health. 2023 May;218:128-135. doi: 10.1016/j.puhe.2023.02.021. Epub 2023 Apr 3.
The pandemic has compounded existing inequalities. In the UK, there have been calls for a new cross-government health inequalities strategy. This study aims to evaluate the effectiveness of national governmental efforts between 1997 and 2010, referred to as the National Health Inequalities Strategy (NHIS).
population-based observational study.
Using Global Burden of Disease data, age-standardised years of life lost due to premature mortality (YLL) rates per 10,000 were extracted for 150 Upper Tier Local Authority (UTLA) regions in England for every year between 1990 and 2019. The slope index of inequality was calculated using YLL rates for all causes, individual conditions, and risk factors. Joinpoint regression was used to assess the trends of any changes which arose before, during or after the NHIS.
Absolute inequalities in YLL rates for all causes remained stable between 1990 and 2000, before decreasing over the following 10 years. After 2010, improvements slowed. A similar trend can be observed amongst inequalities in YLLs for individual causes, including ischaemic heart disease, stroke, breast cancer and lung cancer amongst females, and ischaemic heart disease stroke, diabetes and self-harm amongst males. This trend was also observed amongst certain risk factors, notably blood pressure, cholesterol, tobacco and dietary risks. Inequalities were generally greater in males than in females; however, trends were similar across both sexes. The NHIS coincided with significant reductions in inequalities in YLLs due to ischaemic heart disease and lung cancer.
The findings suggest that the NHIS coincided with a reduction in health inequalities in England. Policy makers should consider a new cross-government strategy to tackle health inequalities drawing from the success of the previous NHIS.
大流行加剧了现有的不平等现象。在英国，有人呼吁制定新的跨政府健康不平等战略。本研究旨在评估 1997 年至 2010 年期间（称为国家卫生不平等战略（NHIS））国家政府努力的有效性。
基于人群的观察性研究。
使用全球疾病负担数据，从 1990 年到 2019 年，每年从英格兰 150 个上层地方当局（UTLA）地区提取每 10000 人因过早死亡而导致的预期寿命损失年（YLL）的年龄标准化率。使用所有原因、个体疾病和危险因素的 YLL 率计算不平等斜率指数。使用 Joinpoint 回归评估 NHIS 之前、期间和之后出现的任何变化趋势。
所有原因的 YLL 率的绝对不平等在 1990 年至 2000 年之间保持稳定，然后在接下来的 10 年中下降。2010 年后，改善速度放缓。在个体疾病导致的 YLL 不平等中也可以观察到类似的趋势，包括女性中的缺血性心脏病、中风、乳腺癌和肺癌，以及男性中的缺血性心脏病、中风、糖尿病和自残。在某些危险因素中也观察到了类似的趋势，尤其是血压、胆固醇、烟草和饮食风险。男性的不平等通常大于女性；然而，两性的趋势相似。NHIS 恰逢缺血性心脏病和肺癌导致的 YLL 不平等显著减少。
研究结果表明，NHIS 恰逢英格兰健康不平等状况的减少。政策制定者应考虑制定新的跨政府战略，从之前 NHIS 的成功中吸取经验，解决健康不平等问题。
