基于地理加权回归的老年人口健康预期寿命影响因素分析

目的:分析我国老年人口健康预期寿命的影响因素,并对相关因素的空间变异特征进行深入探讨。方法:以第六次人口普查数据和《2011年中国卫生统计年鉴》数据为资料来源,采用经典OLS回归和地理加权回归,分析男性和女性老年人口健康预期寿命及各影响因素间的区域差异。结果:经典OLS回归显示,人均可支配收入和平均受教育年限对男性和女性老年人口健康预期寿命均具有正向效应,而每万人拥有卫生机构床位数仅对男性老年人有负向效应。地理加权回归显示,老年人口健康预期寿命分布特征受经济、教育、卫生等非空间因素的影响,还与不同区域的地理分布有密切关系。结论:地理加权回归模型对具有空间自相关性的数据具有更优的拟合,可以较好地揭示空间因素在地区间作用的差异。我国政府制定区域人口老龄化健康政策,应科学把握不同地区对政策背后同一因素的不同反馈作用。     

发达国家预期寿命变化和原因及对我国的启示

预期寿命是度量人口健康状况的最重要指标,也是衡量一个国家或地区经济社会发展和医疗卫生服务水平的综合指标,并受生物学因素、环境因素、生活方式以及医疗卫生服务等因素的影响.新中国成立以来,我国人口预期寿命不断提高,由建国初期的35岁,上升至1982年的68岁,2010年的74.8岁,上海、天津、北京等经济发达地区预期寿命已超过80岁,但还有一些经济欠发达省份预期寿命尚未达到70岁.201 1年,《国民经济和社会发展第十二个五年规划纲要》提出"人均预期寿命提高1岁"的预期性指标,如何达到这一目标,如何缩小不同省份居民预期寿命的差距,是亟待我们研究的课题之一.笔者拟从流行病学范畴(探讨死亡模式的改变)和社会经济学范畴(分析死亡模式转变的根本原因)来分析日本、韩国、美国等国家预期寿命变化的历程及原因,对提高我国人均预期寿命工作有一定启示.     

2013年中国居民预期寿命和去死因预期寿命分析

目的 系统分析2013年我国不同地区、不同人群预期寿命及主要疾病对预期寿命的影响程度,揭示我国经济和社会发展对居民健康水平及公平性提高的影响和作用。方法 综合利用国家统计局人口普查及国家卫生和计划生育委员会人口死亡登记数据,采用指数模型、漏报调整及简略寿命表等方法,系统估算我国居民2013年人均预期寿命水平及疾病影响程度。结果 2013年我国居民预期寿命为75.8岁,较2010年的74.8岁提高约1岁。其中城市约为77.4岁,农村约为75.1岁,城乡差距约为2.3岁;东部地区约为77.2岁,中部地区约为75.8岁,西部地区约为73.5岁,东西地区差距约为3.6岁。2013年造成我国居民预期寿命损失的前10位疾病分别为脑血管病,缺血性心脏病,慢性阻塞性肺病,肺、气管和支气管癌,道路伤害,肝癌,胃癌,高血压心脏病,下呼吸道感染,食道癌,共造成寿命损失7.97岁。结论 我国居民预期寿命已处于较高水平,地区间差异依然存在,应制定针对不同地区的疾病管理、医疗救治及危险因素干预政策,使预期寿命进一步提高,并提高生存质量。     

山西省居民预期寿命及其影响因素分析

目的了解山西省居民预期寿命水平,并探讨其影响因素。方法采用SAS13．0软件编制普查人口简略寿命表;用系统聚类法分析经济状况、卫生事业发展水平对居民预期寿命的影响。结果2010年山西省居民预期寿命为77．07岁,其中男性为75．02岁,女性为79．39岁,比2000年分别提高4．40岁、4．07岁和4．78岁,城镇居民预期寿命高于农村。2010年11个市居民预期寿命仍为太原市最高,晋城市最低。聚类分析结果显示,山西省经济及卫生事业发展越好的地区预期寿命越高。不同地理位置居民预期寿命有所差别,中部地区居民预期寿命较高。结论山西省居民预期寿命不断提高,社会经济、卫生事业发展水平以及自然环境因素是影响居民预期寿命的重要因素。     

影响中国人口平均预期寿命的社会因素模式

本文以全国28个省、自治区和直辖市的统计资料为基础,以文化、经济等社会因素作为自变量,平均预期寿命作为因变量,应用多元线性回归分析,对影响我国人口平均预期寿命的社会因素模式作一讨论。结果提示:努力提高人民文化水平,发展社会主义经济和促进医疗卫生事业的发展是提高人口预期寿命的重要“社会处方”。     

人均预期寿命差距的健康决定因素贡献度研究

目的:系统性分解健康决定因素不平等对人均预期寿命差距的贡献度,探索公共政策可干预的优先领域,提出缩小国家或地区间健康差距的政策建议.方法:利用1990—2017年跨国面板数据,在分组构建宏观健康生产方程和回归分析的基础上,利用Oaxaca-Blinder分解技术对高、低寿命国家组间差距进行分解,计算出各因素对寿命差距的贡献度.结果:总体人均预期寿命差距绝大部分(92.8%)可由健康决定因素不平等解释(可干预的资源型差异),不可解释部分(难以干预的结构型差异)仅占7.2%;在可解释部分,受教育程度贡献度最高(34.4%),其次是人均GDP(26.8%)和安全饮水覆盖率(26.2%),三者共占87.4%;在因素分类贡献度中,社会经济地位因素对于寿命差距贡献度最高(60.9%),医疗卫生体系因素贡献度为6.5%.结论:健康弱势国家应主动建立以健康为导向的资源可持续发展路径,必要时采取国家内部跨地区资源转移战略;明确健康发展的优先领域,兼顾跨领域资源统筹协调;加强发达国家对弱势国家资源发展的国际投资与援助,协作构建人类卫生健康共同体.     

我国分省预期寿命的变化趋势及原因分析

目的 全面系统分析我国31个省（自治区、直辖市）预期寿命发展水平、所处阶段与发展规律,为制定有针对性的预期寿命提升政策、助力卫生健康事业高质量发展提供科学依据。方法 利用国家统计局公布的人口普查结果及国家卫生健康委寿命表资料,通过Arriaga差异分解与普雷斯顿曲线,分析预期寿命增长变化的原因。结果 30年间,我国预期寿命省份间差异从15.26岁降至10.36岁,差距缩小近5岁,低预期寿命地区表现出更为强劲的增长潜能。从普雷斯顿曲线看,我国社会经济发展的健康收益良好;从差异分解结果看,我国31个省（自治区、直辖市）居民健康水平处于不同的发展阶段。结论 我国的健康公平性显著改善,不同地区仍处于不同发展阶段,要因地制宜地制定政策。     

2014年广西死因监测点居民预期寿命及减寿情况分析

目的 分析2014年广西死因监测点数据,了解居民预期寿命及减寿情况,为相关部门制定策略提供科学依据.方法 资料采用国际疾病分类ICD-10对所患疾病进行死因编码,制作简略寿命表和去死因寿命表,对减寿人年数进行分析.结果 2014年广西死因监测点居民预期寿命为78.29岁,男性低于女性,城市地区高于农村地区,去除前五位死因后预期寿命有不同程度的提高.恶性肿瘤、伤害、心脑血管疾病减寿人年数较高.结论 恶性肿瘤、伤害、心脑血管疾病等已成为危害广西居民身体健康、影响社会和经济可持续发展的严重公共卫生问题和社会问题,是未来卫生战略控制的重点.     

如何有效促进人口生育水平提升——基于江苏省人口出生率影响因素的实证分析

目的：从江苏省13个地级市的宏观角度，分析江苏省人口出生率的关键影响因素，为有效促进江苏省生育水平提升，推动人口长期均衡发展提出对策建议。方法：基于2016～2020年江苏省13个地级市的宏观数据，利用面板回归模型进行实证分析，考察江苏省人口出生率的影响因素。结果：基准回归结果显示城镇化率(P<0.05,β=0.212)和平均预期寿命(P<0.05,β=0.149)会显著提高江苏出生率，居民消费价格指数(P<0.05,β=-1.04)和居民人均收入(P<0.01,β=-8.31)则会显著降低江苏出生率。加入固定效应后，仅有卫生机构数对出生率有显著的负向影响(P<0.05,β=-4.959)。而异质性分析结果显示，不同城镇化率和不同居民人均收入水平对出生率的影响存在差异。结论：可以通过降低家庭育儿的经济成本、优化医疗资源配置和加强生育配套服务体系建设等措施来提升江苏省生育水平，促进人口长期均衡发展。     

中国的死亡率进度效应与去进度效应平均预期寿命

目的：介绍死亡率进度效应，其也是高估中国人口平均预期寿命的不可忽略的因素之一，说明去进度效应平均预期寿命是衡量人口寿命水平和健康水平变动趋势的更佳指标。方法：采用1994-2016年中国的死亡数据，以John Bongaarts和Griffith Feeney提出的三步估计策略，考察了中国的去进度效应平均预期寿命。结果与结论：（1）与常规预期寿命指标相比，去进度效应平均预期寿命呈更加平稳增长的趋势，女性的平均预期寿命及其增长速度均高于男性；（2）中国1994-2016年平均预期寿命的进度效应在2~5岁之间波动，平均在2.5岁以上，明显高于已有研究所涉及欧美国家的进度效应，表明中国死亡率下降速度更快；（3）就"六普"而言，进度效应会造成常规平均预期寿命高估寿命水平，男性、女性和两性合计人口的幅度分别为2.43岁、2.63岁和2.57岁，去进度效应预期寿命或许可以更好地测度中国人口的寿命水平及其变化趋势。     

We carry history within us: Anti-Black racism and the legacy of lynchings on life expectancy in the U.S. South

The United States lags in life expectancy compared to most of the world's similarly wealthy nations, driven by pronounced regional disparities particularly between the South and the rest of the country. The U.S. South has a violent history of lynchings of Black Americans by White mobs after the ending of slavery and up to the Civil Rights Era. Building on critical race scholarship, the objective of this study was to determine whether there exists an association between historical lynchings and overall life expectancies in the U.S. South. We created a cross-sectional county-level data set with 1221 data points utilizing data from the Equal Justice Initiative and Robert Wood Johnson Foundation Country Health Rankings. The average life expectancy for 2019–2020 was 76.1 years, ranging from 68.2 years to 90.2 years. Overall life expectancy was found to be highest (76.6) in counties with no recorded lynchings, and lowest (75.5) in counties with the most lynchings (p < .001). In the spatially enabled regression model, the history of lynching along with other covariates explained 57.1% of the variance in life expectancies across the study area. Counties with a history of lynchings also score lower compared to the reference group in various socioeconomic indicators, including median household incomes and high school graduation rates. The findings suggest that lynchings were pivotal in creating the social and physical environment affecting health outcomes in the U.S. South today. We call for further public health research which acknowledges and explores this form of violent and institutional anti-Black racism as foundational to the nation's regional health disparities.     

中国人均预期寿命时空变化及影响因素分析

运用变异系数和灰色关联分析法,对中国人均预期寿命时空变化特征及影响因素的强度进行研究。结果表明:(1) 1981—2015年,我国人均预期寿命增长经历了慢—快—慢—快的四个阶段,预期寿命增长指数上升到113,其中男性上升到111,女性上升到115,男女预期寿命差距逐步增大。(2) 1990—2010年,全国31个省份人均预期寿命变异系数从0. 051降低到0. 036,预期寿命水平较低省份的增长速度明显高于较高的省份。(3)我国人均预期寿命的地域分布大体上分为东南部高预期寿命水平区、中北部中预期寿命水平区、西南部低预期寿命水平区。2010年我国人均预期寿命水平绝大多数省份处于第二级(76～80岁)和第三级(71～75岁),相对于1990年提高了两级。到2020年,我国将有北京、天津和上海3市处于第一级寿命水平(81～85岁),其余为第二和第三级预期寿命水平。影响我国省际人均预期寿命时空差异的因素是多方面的,其中最主要的是各地区的经济发展、医疗服务和医疗保障水平。     

The gap gets bigger: changes in mortality and life expectancy, by education, 1981-2000

In this paper we examine educational disparities in mortality and life expectancy among non-Hispanic blacks and whites in the 1980s and 1990s. Despite increased attention and substantial dollars directed to groups with low socioeconomic status, within race and gender groups, the educational gap in life expectancy is rising, mainly because of rising differentials among the elderly. With the exception of black males, all recent gains in life expectancy at age twenty-five have occurred among better-educated groups, raising educational differentials in life expectancy by 30 percent. Differential trends in smoking-related diseases explain at least 20 percent of this trend.     

Regional differences in healthy life expectancy in The Netherlands

BACKGROUND: Healthy life expectancy has mainly been studied at the level of healthcare systems rather than at regional level within healthcare systems. In this article, healthy life expectancy at birth and at 65 years of age for men and women in the Netherlands has been described, and factors related to these regional variations have been explored. METHODS: Ecological study of 27 healthcare regions (hospital catchment areas). Life expectancy and healthy life expectancy were calculated using 1995 mortality data and pooled health interview survey data (1992-1997) from Statistics Netherlands. RESULTS: Healthy life expectancy shows a regional pattern, slightly different from that found in life expectancy and self-reported health. The regional distribution of male and female healthy life expectancy is different, especially at 65 years. Healthy life expectancy of women aged 65 years is independent of their total life expectancy. Social conditions and lifestyle differences between regions are negatively associated with healthy life expectancy in Dutch regions. Healthcare supply variables show no clear relationship. CONCLUSION: Although the Netherlands is a small, homogeneous country, substantial differences were found in healthy life expectancy.     

中国少数民族预期寿命变化研究

本文利用全国第三次和第四次人口普查资料，对我国少数民族预期寿命的变化特点，规律进行了探讨，结果表明，自八十年代初至九十年代初，我国大多数少数民族的预期寿命有所增加，即健康水平有所改善。少数民族的医疗服务水平和文化毒手进影响预期寿命变化的主要社会因素，作者还针对我国少数民族目前所存在的问题，提出了有关进一步改善其健康状况的建议。     

Racial and social class gradients in life expectancy in contemporary California

Life expectancy, or the estimated average age of death, is among the most basic measures of a population's health. However, monitoring differences in life expectancy among sociodemographically defined populations has been challenging, at least in the United States (US), because death certification does not include collection of markers of socioeconomic status (SES). In order to understand how SES and race/ethnicity independently and jointly affected overall health in a contemporary US population, we assigned a small-area-based measure of SES to all 689,036 deaths occurring in California during a three-year period (1999–2001) overlapping the most recent US census. Residence at death was geocoded to the smallest census area available (block group) and assigned to a quintile of a multifactorial SES index. We constructed life tables using mortality rates calculated by age, sex, race/ethnicity and neighborhood SES quintile, and produced corresponding life expectancy estimates. We found a 19.6 (±0.6) year gap in life expectancy between the sociodemographic groups with the longest life expectancy (highest SES quintile of Asian females; 84.9 years) and the shortest (lowest SES quintile of African–American males; 65.3 years). A positive SES gradient in life expectancy was observed among whites and African–Americans but not Hispanics or Asians. Age-specific mortality disparities varied among groups. Race/ethnicity and neighborhood SES had substantial and independent influences on life expectancy, underscoring the importance of monitoring health outcomes simultaneously by these factors. African–American males living in the poorest 20% of California neighborhoods had life expectancy comparable to that reported for males living in developing countries. Neighborhood SES represents a readily-available metric for ongoing surveillance of health disparities in the US.     

Linking Data on Constituent Health with Elected Officials’ Opinions: Associations Between Urban Health Disparities and Mayoral Officials’ Beliefs About Health Disparities in Their Cities

Policy Points

• Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income‐based life expectancy disparity in their city.
• Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents.
• Highly visible and publicized information about mortality disparities, such as that related to COVID‐19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.

ContextA substantive body of research has explored what factors influence elected officials’ opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official''s constituents. We assessed whether the magnitude of income‐based life expectancy disparity within a city was associated with the opinions of that city''s mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.MethodsThe independent variable was the magnitude of income‐based life expectancy disparity in US cities. The magnitude was determined by linking 2010‐2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials’ opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics.FindingsIn cities in the highest income‐based life expectancy disparity quartile, 50.0% of mayoral officials “strongly agreed” that health disparities existed and 52.7% believed health disparities were “very unfair.” In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% “strongly agreed” that health disparities existed and 22.2% believed the disparities were “very unfair.” A 1‐year‐larger income‐based life expectancy disparity in a city was associated with 25% higher odds that the city''s mayoral official would “strongly agree” that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city''s mayoral official would believe that such disparities were “very unfair” (OR = 2.24; P <.001).ConclusionsMayoral officials’ opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income‐based life expectancy disparities among their constituents.     

Regional differences in trends in life expectancy and the influence of the political and socioeconomic contexts in Germany.

The aim of the study is to investigate to what extent trends in life expectancy are influenced by political variables and socioeconomic characteristics that play a role at the regional level of the federal states in Germany. Data on life expectancy in males and females at birth are analyzed from 1986 to 1998 for 12 federal states in Eastern and Western Germany. These states are classified into five types of political government since 1980: (1) long-term Christian democratic, (2) long-term social democratic, (3) change from Christian to social democratic, (4) change from communist to social democratic, and (5) change from communist to Christian democratic. The study showed three main results. First, life expectancy has been directly influenced by the major political forces that determined policies in East and West Germany. Second, life expectancy was higher in federal states with predominantly Christian democratic governments than in those with predominantly social democratic governments. Third, life expectancy was strongly related to the economic power of the federal states. Because federal states characterized by a more prosperous economic situation were those with a predominantly Christian democratic government, while federal states with a less prosperous situation were mostly governed by social democrats, it is difficult to disentangle the effects of economic and political factors on life expectancy. Nevertheless, this study underlines the importance of politics and policies on such robust and more general health indicators as mean life expectancy at birth.     

Trends in infant/child mortality and life expectancy in Indigenous populations in Yunnan Province, China

OBJECTIVE: The 2000 Census in China registered 55 groups of Indigenous population, including 104.49 million people, making up 8.1% of China's total population. Yunnan Province, located in Southwest China, is the only province where all 55 Indigenous nationalities are represented (14.15 million), making up 33.4% of Yunnan's total population. This study aimed to examine trends in infant and child mortality and life expectancy at birth of the 22 largest Indigenous nationalities and compared these trends with those of the majority Han Chinese in Yunnan and China as a whole. METHODS: Data sources of mortality and socioeconomic status came from the population censuses of China (1953, 1964, 1982, 1990, and 2000) and Yunnan (1990-2000) and from the Provincial Health Department (1990, 1995, 1996 and 2000). Weighted linear regression analysis was used to examine the associations between infant/child mortality and life expectancy at birth, socioeconomic indicators and the use of preventive health services. RESULTS: In 2000, the infant mortality rate was 26.90 for China and 53.64 for Han Chinese in Yunnan per 1,000 live birth versus 77.75 for the 22 largest minority nationalities in Yunnan, despite improvements in health status indicators since 1990. The inequalities in life expectancy at birth between China as a whole and some minority nationalities remained striking in 2000 (57.18 versus 71.40). Literacy, prenatal examination, hospital deliveries, economic development were important predictors of these health indicators. IMPLICATIONS: Efforts to continue to improve these intermediate proximate determinants and to target the most disadvantaged Indigenous groups are likely to further reduce health disparities between the Chinese and Indigenous populations.