丹麦三十年来邻里社会经济劣势与死亡率差异的趋势
Trends in neighbourhood socioeconomic disadvantage and mortality disparities over three decades in Denmark.
作者信息
Foverskov Else, Frøslev Trine, Kim Min Hee, Hamad Rita
机构信息
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
出版信息
J Epidemiol Community Health. 2025 Jun 25. doi: 10.1136/jech-2025-224096.
BACKGROUND
Negative associations between neighbourhood socioeconomic disadvantage and health are well documented. However, limited longitudinal evidence exists on the dynamic nature of the neighbourhood context and implications for health disparities. Using rich register data, we examined how neighbourhood disadvantage in Denmark changed over three decades and explored associations with mortality rates.
METHODS
This ecological study used nationwide register data from 1987 to 2018. A neighbourhood socioeconomic disadvantage index was created using aggregated data on neighbourhood-level educational attainment, unemployment and family income. Trends in the neighbourhood index were assessed using descriptive and geospatial analyses. Associations with age-standardised mortality rates were plotted and examined in regression-based models.
RESULTS
Neighbourhood socioeconomic conditions generally improved over the three decades, and the mean difference between disadvantaged quartiles narrowed. The location of the most and least disadvantaged quartiles was largely stable across the period. Mortality rates generally decreased over time; however, rates of decline differed, leading to increased mortality disparities by quartile of neighbourhood disadvantage. Regression analysis demonstrated an increase in the association between neighbourhood disadvantage and mortality rates over time. First-difference regression models showed no association between change in neighbourhood disadvantage and change in mortality rates.
CONCLUSIONS
Despite general improvements in neighbourhood socioeconomic conditions and neighbourhood mortality rates across the last three decades in Denmark, we found growing health inequality between more and less disadvantaged neighbourhoods. A strong concentration of disadvantage over time and space and growing segregation of income levels may have contributed to this development, with important implications for public policy and health policy investments.
背景
邻里社会经济劣势与健康之间的负面关联已有充分记录。然而，关于邻里环境的动态性质及其对健康差距的影响，纵向证据有限。利用丰富的登记数据，我们研究了丹麦邻里劣势在三十年中的变化情况，并探讨了其与死亡率的关联。
方法
这项生态学研究使用了1987年至2018年的全国登记数据。利用邻里层面教育程度、失业率和家庭收入的汇总数据创建了一个邻里社会经济劣势指数。使用描述性和地理空间分析评估邻里指数的趋势。绘制与年龄标准化死亡率的关联，并在基于回归的模型中进行检验。
结果
在这三十年中，邻里社会经济状况总体上有所改善，劣势四分位数之间的平均差异缩小。最劣势和最不劣势四分位数的位置在整个时期基本稳定。死亡率总体上随时间下降；然而，下降速度不同，导致邻里劣势四分位数之间的死亡率差距加大。回归分析表明，邻里劣势与死亡率之间的关联随时间增加。一阶差分回归模型显示，邻里劣势的变化与死亡率的变化之间没有关联。
结论
尽管丹麦在过去三十年中邻里社会经济状况和邻里死亡率总体上有所改善，但我们发现，劣势程度不同的邻里之间的健康不平等在加剧。随着时间的推移和空间的变化，劣势高度集中以及收入水平的隔离加剧可能促成了这一发展，这对公共政策和卫生政策投资具有重要意义。
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