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[1997年至2017年阿根廷冬季的超额死亡率:基于公共卫生的方法以及来自全球南方的认知争议]

[Excess mortality in winter in Argentina from 1997 to 2017: an approach based on public health and an epistemic dispute from the Global South].

作者信息

Almeida Virna, Alazraqui Marcio

机构信息

Departamento de Epidemiología e Información Estratégica en Salud, Hospital de Alta Complejidad El Calafate, El Calafate, Argentina.

Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina.

出版信息

Cad Saude Publica. 2025 Jun 20;41(5):e00168524. doi: 10.1590/0102-311XES168524. eCollection 2025.


DOI:10.1590/0102-311XES168524
PMID:40561264
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12185044/
Abstract

Excess mortality in winter is studied in the Global North as a manifestation of social inequalities and avoidable deaths. It has a complex identification that differs from general mortality. This study aims to highlight the occurrence of excess winter mortality in Argentina from 1997 to 2017. Also, it describes excess mortality magnitude, trend, and distribution in order to discuss it based on a critical perspective as an object of knowledge for public health. Official mortality databases were used for a study of time series at the national, regional and provincial levels, integrating spatial and temporal aggregates. In total, 407,950 excess deaths were identified in winter, with an annual average of 16,667 (20.4%; 95%CI: 18.6; 22.2). A higher prevalence was found in women (21.8%; 95%CI: 20.5; 24.9) than in men (18.2%; 95%CI: 16.2; 19.5). Of this total, 92.3% occurred in older women aged over 60 years, with a predominance of those older than 80 years (63%) and men aged from 60 to 79 years (49.7%). Excess winter mortality was also found in children aged under 5 years, but not in men aged 15 to 29 years. The nadir occurred in 2010 (15%; 95%CI: 14.7; 15.2) and the peak in 1999 (30.5%; 95%CI: 30.2; 30.9). Latitude explained 75% of the variability between provinces (adjusted R² = 0.75). It is concluded that women, children aged under 5 years, older people aged over 60 years and residents of the Central and Cuyo regions were the most affected. Based on a proxy indicator, this work shows inequalities in mortality that are probably unfair and avoidable, synthesizing individual and collective vulnerabilities. Its pioneering aspect lies in carrying out a critical approach from the Global South, providing knowledge relevant to Public Health.

摘要

在全球北方地区,冬季超额死亡率被视为社会不平等和可避免死亡的一种表现形式进行研究。它有着与一般死亡率不同的复杂识别方式。本研究旨在突出1997年至2017年阿根廷冬季超额死亡率的发生情况。此外,还描述了超额死亡率的规模、趋势和分布,以便从批判性视角将其作为公共卫生知识的对象进行讨论。官方死亡率数据库被用于国家、地区和省级层面的时间序列研究,整合了空间和时间总量。总共在冬季识别出407,950例超额死亡,年均16,667例(20.4%;95%置信区间:18.6;22.2)。女性的患病率(21.8%;95%置信区间:20.5;24.9)高于男性(18.2%;95%置信区间:16.2;19.5)。在这一总数中,92.3%发生在60岁以上的老年女性中,其中80岁以上者占主导(63%),60至79岁的男性占49.7%。5岁以下儿童也存在冬季超额死亡率,但15至29岁男性中未出现。最低点出现在2010年(15%;95%置信区间:14.7;1;5.2),最高点出现在1999年(30.5%;95%置信区间:30.2;30.9)。纬度解释了各省之间75%的变异性(调整后的R² = 0.75)。得出的结论是,女性、5岁以下儿童、60岁以上老年人以及中部和库约地区的居民受影响最大。基于一个代理指标,这项工作显示出死亡率方面可能不公平且可避免的不平等,综合了个体和集体的脆弱性。其开创性在于从全球南方地区采取批判性方法,提供了与公共卫生相关的知识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/d8766d965869/1678-4464-csp-41-05-ES168524-gf5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/f3c3d5468836/1678-4464-csp-41-05-ES168524-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/d33394f97ef2/1678-4464-csp-41-05-ES168524-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/825452d71797/1678-4464-csp-41-05-ES168524-gf3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/63926d828d1d/1678-4464-csp-41-05-ES168524-gf4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/d8766d965869/1678-4464-csp-41-05-ES168524-gf5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/f3c3d5468836/1678-4464-csp-41-05-ES168524-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/d33394f97ef2/1678-4464-csp-41-05-ES168524-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/825452d71797/1678-4464-csp-41-05-ES168524-gf3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/63926d828d1d/1678-4464-csp-41-05-ES168524-gf4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcab/12185044/d8766d965869/1678-4464-csp-41-05-ES168524-gf5.jpg

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本文引用的文献

[1]
The 2023 Latin America report of the Countdown on health and climate change: the imperative for health-centred climate-resilient development.

Lancet Reg Health Am. 2024-4-23

[2]
Argentina's healthcare is crumbling under its worst ever dengue epidemic and Milei's presidency.

BMJ. 2024-4-23

[3]
[Dengue in Argentina: confirmation of our worst suspicions].

Rev Fac Cien Med Univ Nac Cordoba. 2024-3-27

[4]
Beyond the sine wave: unveiling climate-driven baseline mortality cycles.

Int J Biometeorol. 2024-5

[5]
The rise and fall of excess winter mortality in New Zealand from 1876 to 2020.

Int J Biometeorol. 2024-1

[6]
Spatial Inequities in Life Expectancy in Small Areas of Buenos Aires, Argentina 2015-2017.

J Urban Health. 2023-6

[7]
Extreme temperatures and mortality in Latin America: Voices are needed from the Global South.

Med. 2022-10-14

[8]
Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities.

BMC Public Health. 2022-8-5

[9]
City-level impact of extreme temperatures and mortality in Latin America.

Nat Med. 2022-8

[10]
Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends.

Int J Environ Res Public Health. 2022-3-14

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