Grant Ian, Chalmers Neil, Fletcher Eilidh, Lakha Fatim, McCartney Gerry, Stockton Diane, Wyper Grant M A
Public Health Scotland, Edinburgh, UK.
NHS Tayside, Dundee, UK.
BMJ Public Health. 2023 Dec 1;1(1):e000191. doi: 10.1136/bmjph-2023-000191. eCollection 2023 Nov.
Health inequalities in Scotland are well documented, including the contribution of different causes to inequalities in mortality. Our aim was to estimate inequalities within a burden of disease framework, accounting for both premature mortality and the effects of morbidity, to understand the contribution of specific diseases to health inequalities prior to the COVID-19 pandemic.
Disability-adjusted life-years (DALYs) for 70 individual causes of disease and injury were sourced from the Scottish Burden of Disease Study. Area-level deprivation was measured using the Scottish Index of Multiple Deprivation. Inequalities were measured by the range, Relative Index of Inequality, Slope Index of Inequality and attributable DALYs were estimated by using the least deprived decile as a reference.
The overall disease burden was double that in the most deprived areas (50 305 vs 20 955 DALYS per 100 000), largely driven by inequalities in premature mortality. The rate in the most deprived areas was around 48% higher than the mean population rate (Relative Index of Inequality=0.96), with 35% of DALYs attributed to differences in area-based deprivation. Many leading causes of disease burden in 2019-heart disease, drug use disorders, lung cancer and chronic obstructive pulmonary disease-were also the leading drivers of absolute and relative inequalities in the disease burden.
Our study evidences the extent of the stark levels of absolute and relative inequality prior to the COVID-19 pandemic. Given prepandemic stalling of mortality trend improvements and widening health inequalities, and the exacerbation of these caused by COVID-19, urgent policy attention is required to address this.
苏格兰的健康不平等现象有充分记录，包括不同病因对死亡率不平等的影响。我们的目的是在疾病负担框架内估计不平等情况，同时考虑过早死亡和发病的影响，以了解特定疾病在2019冠状病毒病大流行之前对健康不平等的贡献。
70种疾病和损伤个体病因的伤残调整生命年（DALYs）数据来自苏格兰疾病负担研究。使用苏格兰多重剥夺指数衡量地区层面的贫困程度。通过范围、不平等相对指数、不平等斜率指数来衡量不平等情况，并以最不贫困的十分位数作为参考来估计可归因的伤残调整生命年。
最贫困地区的总体疾病负担是其他地区的两倍（每10万人中分别为50305和20955个伤残调整生命年），这在很大程度上是由过早死亡的不平等所驱动。最贫困地区的发病率比平均人口发病率高约48%（不平等相对指数=0.96），35%的伤残调整生命年可归因于地区贫困差异。2019年许多导致疾病负担的主要原因——心脏病、药物使用障碍、肺癌和慢性阻塞性肺疾病——也是疾病负担中绝对和相对不平等的主要驱动因素。
我们的研究证明了在2019冠状病毒病大流行之前绝对和相对不平等的严重程度。鉴于大流行前死亡率趋势改善停滞以及健康不平等加剧，再加上2019冠状病毒病造成的这些情况恶化，迫切需要政策关注来解决这一问题。
