Mackenbach J P, Looman C W
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
J Epidemiol Community Health. 1994 Apr;48(2):140-5. doi: 10.1136/jech.48.2.140.
The association between living standards and mortality in the European Community (EC) was investigated using regional level data from all EC member countries.
Data covering the 1980s were extracted from various publications. Data on "all cause" mortality (standardised mortality ratios, both sexes, all ages), living standards (gross domestic product, car access, unemployment rates), and some potential confounders (population density, agricultural employment, industrial employment, country) were available for 133 regions. Multiple regression analysis was used for each living standard variable, taking lnSMR as the dependent variable.
It is only after taking into account potential confounders that higher living standards are associated with lower mortality. Unemployment rates have the strongest association--each additional percentage in unemployment in the regional population is associated with an increase in mortality by 0.81%. There is important variation between countries in the living standards--mortality relationship. The latter ranges from relatively strong in the UK to absent in Italy.
The results of this study show that there is an association between living standards and mortality at the regional level in the EC, but that this association comes to light only after controlling for confounding variables. It seems that the mortality increasing effects of urbanisation and industrialization have obscured the mortality lowering effects of high living standards. In addition, factors specific to countries (such as dietary habits) act as confounders. The latter finding is interpreted in the light of differences between countries in the way in which they have gone through the "epidemiologic translation" from infectious diseases to the "western" diseases that currently dominate the mortality pattern.
利用来自所有欧盟成员国的区域层面数据，对欧盟（EC）生活水平与死亡率之间的关联进行调查。
从各种出版物中提取了涵盖20世纪80年代的数据。有133个区域提供了“全因”死亡率（标准化死亡率，男女皆有，所有年龄段）、生活水平（国内生产总值、汽车保有量、失业率）以及一些潜在混杂因素（人口密度、农业就业、工业就业、国家）的数据。以lnSMR作为因变量，对每个生活水平变量进行多元回归分析。
只有在考虑潜在混杂因素之后，较高的生活水平才与较低的死亡率相关。失业率的关联最为强烈——区域人口中失业率每增加一个百分点，死亡率就会增加0.81%。生活水平与死亡率之间的关系在不同国家之间存在重要差异。这种关系在英国相对较强，而在意大利则不存在。
本研究结果表明，在欧盟区域层面，生活水平与死亡率之间存在关联，但这种关联只有在控制混杂变量之后才会显现出来。城市化和工业化对死亡率的增加作用似乎掩盖了高生活水平对死亡率的降低作用。此外，国家特有的因素（如饮食习惯）起到了混杂因素的作用。后一个发现是根据各国在从传染病到目前主导死亡模式的“西方”疾病的“流行病学转变”过程中的差异来解释的。
