School of Health Administration, Dalhousie University, Halifax, Canada.
Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics, Lund University, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden.
Soc Sci Med. 2024 Apr;347:116751. doi: 10.1016/j.socscimed.2024.116751. Epub 2024 Mar 10.
This study measures public health policies' and healthcare system's influence, by assessing the contributions of avoidable deaths, on the gender gaps in life expectancy and disparity (GGLD and GGLD, respectively) in the United States (US) and Canada from 2001 to 2019.
To estimate the GGLE and GGLD, we retrieved age- and sex-specific causes of death from the World Health Organization's mortality database. By employing the continuous-change model, we decomposed the GGLE and GGLD by age and cause of death for each year and over time using females as the reference group.
In Canada and the US, the GGLE (GGLD) narrowed (increased) by 0.9 (0.2) and 0.2 (0.3) years, respectively. Largest contributor to the GGLE was non-avoidable deaths in Canada and preventable deaths in the US. Preventable deaths had the largest contributions to the GGLD in both countries. Ischemic heart disease contributed to the narrowing GGLE/GGLD in both countries. Conversely, treatable causes of death increased the GGLE/GGLD in both countries. In Canada, "treatable & preventable" as well as preventable causes of death narrowed the GGLE while opposite was seen in the US. While lung cancer contributed to the narrowing GGLE/GGLD, drug-related death contributed to the widening GGLE/GGLD in both countries. Injury-related deaths contributed to the narrowing GGLE/GGLD in Canada but not in the US. The contributions of avoidable causes of death to the GGLE declined in the age groups 55-74 in Canada and 70-74 in the US, whereas the GGLE widened for ages 25-34 in the US.
Canada experienced larger reduction in the GGLE compared to the US attributed mainly to preventable causes of death. To narrow the GGLE and GGLD, the US needs to address injury deaths. Urgent interventions are required for drug-related death in both countries, particularly among males aged 15-44 years.
本研究通过评估可避免死亡对美国和加拿大 2001 年至 2019 年预期寿命和性别差距（分别为 GGLD 和 GGLD）的影响，衡量公共卫生政策和医疗体系的作用。
为了估计 GGLD 和 GGLE，我们从世界卫生组织的死亡率数据库中检索了按年龄和性别分类的死因。通过使用连续变化模型，我们以女性为参考组，按年龄和死因对每年和随时间推移的 GGLD 和 GGLE 进行了分解。
在加拿大和美国，GGLD（GGLD）分别缩小了 0.9（0.2）和 0.2（0.3）年。加拿大 GGLE 的最大贡献者是非可避免的死亡，而美国的则是可预防的死亡。两国 GGLD 的最大贡献者都是可预防的死亡。缺血性心脏病对两国 GGLD 的缩小都有贡献。相反，可治疗的死因增加了两国的 GGLD。在加拿大，“可治疗和可预防”以及可预防的死亡原因缩小了 GGLE，而美国则相反。肺癌对缩小 GGLD/GGLD 有贡献，而药物相关死亡对两国的 GGLD 扩大有贡献。伤害相关死亡对加拿大的 GGLD 缩小有贡献，但对美国没有贡献。加拿大 55-74 岁和美国 70-74 岁年龄组中可避免死因对 GGLE 的贡献有所下降，而美国 25-34 岁年龄组的 GGLE 则有所扩大。
与美国相比，加拿大的 GGLE 缩小幅度更大，这主要归因于可预防的死亡原因。为了缩小 GGLD 和 GGLE，美国需要解决与伤害有关的死亡问题。两国都需要对与药物有关的死亡采取紧急干预措施，特别是在 15-44 岁的男性中。
