Tarkiainen Lasse, Martikainen Pekka, Junna Liina, Remes Hanna
Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland.
J Epidemiol Community Health. 2024 Mar 8;78(4):241-247. doi: 10.1136/jech-2023-221705.
Socioeconomic inequalities in mortality originate from different causes of death. Alcohol-related and smoking-related deaths are major drivers of mortality inequalities across Europe. In Finland, the turn from widening to narrowing mortality disparities by income in the early 2010s was largely attributable to these causes of death. However, little is known about recent inequalities in life expectancy (LE) and lifespan variation.
We used individual-level total population register-based data with annual information on disposable household income and cause-specific mortality for ages 30-95+, and assessed the contribution of smoking on mortality using the Preston-Glei-Wilmoth method. We calculated trends in LE at age 30 and SD in lifespan by income quintile in 1997-2020 and conducted age and cause-of-death decompositions of changes in LE.
Disparity in LE and lifespan variation by income increased in 2015-2020, largely attributable to the stagnation of both measures in the lowest income quintile. The LE gap between the extreme quintiles in 2018-2020 was 11.2 (men) and 5.9 (women) years, of which roughly 40% was attributable to alcohol and smoking. However, the recent widening of the gap and the stagnation in LE in the lowest quintile over time were not driven by any specific cause-of-death group.
After a decade of narrowing inequalities in LE and lifespan variation in Finland, the gaps between income groups are growing again. Increasing LE disparity and stagnating mortality on the lowest income levels are no longer attributable to smoking and alcohol-related deaths but are more comprehensive, originating from most cause-of-death groups.
死亡率方面的社会经济不平等源于不同的死亡原因。与酒精和吸烟相关的死亡是欧洲死亡率不平等的主要驱动因素。在芬兰，2010年代初死亡率差距从扩大转向缩小在很大程度上归因于这些死亡原因。然而，对于近期预期寿命（LE）不平等和寿命差异情况知之甚少。
我们使用基于个人层面的总人口登记数据，其中包含家庭可支配收入的年度信息以及30 - 95岁及以上特定死因的死亡率，并使用普雷斯顿 - 格莱 - 威尔莫特方法评估吸烟对死亡率的影响。我们计算了1997 - 2020年按收入五分位数划分的30岁时预期寿命趋势和寿命标准差，并对预期寿命变化进行了年龄和死因分解。
2015 - 2020年，按收入划分的预期寿命和寿命差异有所增加，这主要归因于最低收入五分位数群体这两项指标的停滞。2018 - 2020年极端五分位数之间的预期寿命差距男性为11.2岁，女性为5.9岁，其中约40%可归因于酒精和吸烟。然而，近期差距的扩大以及最低五分位数群体预期寿命随时间的停滞并非由任何特定死因组驱动。
在芬兰预期寿命和寿命差异不平等现象缩小十年之后，收入群体之间的差距再次扩大。预期寿命差距不断扩大以及最低收入水平死亡率停滞不再归因于吸烟和与酒精相关的死亡，而是更具综合性，源自大多数死因组。
