World health inequality: convergence, divergence, and development

Recent studies characterize the last half of the twentieth century as an era of cross-national health convergence, with some attributing welfare gains in the developing world to economic growth. In this study, I examine the extent to which welfare outcomes have actually converged and the extent to which economic development is responsible for the observed trends. Drawing from estimates covering 195 nations during the 1955-2005 period, I find that life expectancy averages converged during this time, but that infant mortality rates continuously diverged. I develop a narrative that implicates economic development in these contrasting trends, suggesting that health outcomes follow a "welfare Kuznets curve." Among poor countries, economic development improves life expectancy more than it reduces infant mortality, whereas the situation is reversed among wealthier nations. In this way, development has contributed to both convergence in life expectancy and divergence in infant mortality. Drawing from 674 observations across 163 countries during the 1980-2005 period, I find that the positive effect of GDP PC on life expectancy attenuates at higher levels of development, while the negative effect of GDP PC on infant mortality grows stronger.     

Social gradient in life expectancy and health expectancy in Denmark

Summary Objectives: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.Methods: Health interview data were combined with life table figures using Sullivans method.Results: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level.Conclusions: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.     

40年来我国人民健康水平的变化

本文根据大量卫生统计资料分析了新中国建立40年来我国人民健康水平的变化。统计资料表明,解放前我国人民健康水平很低,传染病广泛流行,婴儿死亡率高达201‰,出生时平均期望寿命仅39岁。中华人民共和国建立40年来,在社会经济及卫生事业发展的基础上,我国人民健康水平显著提高,死亡率由1949年的20‰降为1990年的6.3‰,婴儿死亡率由1944～1949年的201‰降为1985～1987年的37‰,同期出生时平均期望寿命由39岁提高到69岁。传染病流行得到有效控制,慢性退行性病已成为主要死亡原因。我国人民的主要健康指标已在发展中国家中处于先进地位,某些指标已接近经济发达国家水平。     

四川省宣汉县人口寿命表动态分析

本文利用四川省宣汉县四次人口普查资料,用蒋氏法编制出男女性简略寿命表,并对寿命表中主要指标进行动态分析,以了解该县四十年来居民健康状况的变化。     

Social differences in the burden of long-standing illness in Denmark

Summary. Objectives To estimate the impact of diseases on social differences in life expectancy and expected lifetime with illness among Danes in 1995–99. Methods Expected lifetime with and without long-standing illness were calculated for groups with low, medium and high educational levels. Estimates based on observed rates of mortality and prevalence of illness were compared with those based on rates from which a specific disease had been eliminated. Results Partial life expectancy (age 30–75) would increase by almost 1.5 years if cancer were eliminated. Expected lifetime without long-standing illness would increase by approximately 1 year. Elimination of cardiovascular diseases would increase partial life expectancy, mainly among men with a low educational level. If diseases of the musculoskeletal system were eliminated the benefit would be greatest for persons with a low educational level. Conclusions The gain in life expectancy to be expected by eliminating certain diseases decreased with educational level. Elimination of cancer would extend lifetime both with and without illness for all educational levels. Submitted: 27 June 2005; Accepted: 7 March 2006     

Income inequality and population health: correlation and causality

A large literature now exists on the cross-national correlation between income inequality and population health, but existing studies suffer from sparse data, poor operationalization of income inequality, and the use of low-power statistical models. This paper sets out to estimate the ecological correlation between income inequality and indicators of population health in a very broad panel of countries, to demonstrate that this relationship is largely non-artifactual, and to test whether this relationship might be causal. Gini coefficients of national income inequality in 1970 and 1995 are correlated with life expectancy, infant mortality rates, and murder rates, controlling for national income per capita. In cross-sectional analyses, inequality is significantly correlated with life expectancy, infant mortality, and (inconsistently) the murder rate. The health correlations are shown to be not primarily due to the "convexity effect" of the non-linear relationship between individual income and individual health, which seems to account for no more than one-third of the relationship between inequality and health, and likely much less. Change in inequality 1970-1995 is significantly related to change in life expectancy and infant mortality, suggesting a causal relationship, but these correlations are not robust with respect to sample or controls. It can be concluded that there is a strong, consistent, statistically significant, non-artifactual correlation between national income inequality and population health, but though there is some evidence that this relationship is causal, the relative stability of income inequality over time in most countries makes causality difficult to test.     

上海人群主要健康指标分析

该主要对上海与其它发达国家、地区的主要健康指标进行横向比较，总结成绩、发现差距和问题，为新世纪上海居民健康水平进一步提高提供决策依据。     

Rising mortality and life expectancy differentials by lifetime earnings in the United States

Are mortality and life expectancy differences by socioeconomic groups increasing in the United States? Using a unique data set matching administrative and survey data, this study explores trends in these differentials by lifetime earnings for the 1983–2003 period. Results indicate a consistent increase in mortality differentials across sex and age groups. The study also finds a substantial increase in life expectancy differentials by lifetime earnings: the top-to-bottom quintile premium increased 30 percent for men and almost doubled for women. These results complement recent research to point to almost five decades of increasing differential mortality in the United States.     

2013年中国25岁及以上人群高血糖归因死亡对期望寿命的影响

目的 分析2013年中国≥ 25岁人群高血糖归因死亡和期望寿命损失情况。方法 用2013年中国居民死因监测及中国慢性病及其危险因素监测数据,采用人群归因分值估计高血糖危险因素造成的死亡和对期望寿命的影响。结果 2013年中国≥ 25岁人群归因于高血糖的总死亡人数为62.1万,其中男性33.3万,女性28.8万。高血糖造成的相关疾病死亡人数以缺血性心脏病为最多,约21.2万,其次为脑血管病,约18.1万,其余依次为糖尿病（14.5万）、慢性肾病（5.2万）和结核病（3.1万）。去除高血糖危险因素后,2013年中国居民期望寿命可达到76.5岁,较全死因期望寿命平均提高0.7岁。其中,男性提高0.7岁,女性提高0.8岁。结论 高血糖是影响中国居民死亡和期望寿命的重要危险因素之一。应加强高血糖及相关疾病的预防控制。     

Socio-economic inequalities in health expectancy in Belgium

Various international studies have demonstrated socio-economic differences in health. Linking the 1991 Census to the National Register and using the Health Interview Survey 1997 has enabled assessment of the association between the level of education and health in Belgium using the composite indicator 'health expectancy'. The Sullivan method was used to calculate health expectancy on the basis of current probability of death and prevalence of perceived health. Two measures of educational attainment were used: absolute educational attainment and the position on a relative hierarchical educational scale obtained by a regression-based method. The latter measure enables international comparisons. Differences in health expectancy by education were spread over the whole range of the educational hierarchy, and were consistently larger among females than males. At 25 years of age, the difference in health expectancy between different levels of education reached up to 17.8 and 24.7 years in males and females, respectively. Compared with people with the highest educational attainment, males and females at the lowest level of education spent more than 10 and 20 additional years in poor perceived health, respectively. Between ages 25 and 75 years, the difference in health expectancy between people with the lowest and highest levels of education was 17 years among males and 21 years among females. Compared with people at the top of the relative educational scale, males and females at the bottom of the scale had 13.6 and 19.7 additional years in poor perceived health, respectively. The conclusions of this study in Belgium are consistent with studies in other countries. People with a low level of education have shorter lives than people with a higher level of education. They also have fewer years in good perceived health, and can expect more years in poor health in their shorter lives. The inequality in health expectancy seems to be greater in females than males.     

Expectancy of working life of mine workers in hunan province

From demographic mortality and disability of, in total, 424 965y from workers in 29 coal or coloured/metal mines in Hunan province of China during the period 1980–1984, we calculated the length of expected working life (EWL) as well as the life expectancy (EL) of the workers in the different types of mines and between those working on the surface and those working underground.The average life expectancy in the coal mines for those starting work at 15 y was found to be 58.91 y and 49.23 y for surface and underground workers respectively. In the coloured/metal mines they were 60.24 y and 56.55 y respectively.If only the mortality data was taken into account; for the coal mines, the EWL at the age of 15 y of surface workers and underground workerrs was 48.46 and 45.10 y respectively: whilst in the coloured/metal mines the figures were 48.25 and 45.99 y respectively. If both mortality and morbidity data is used the EWL at the same age and in the same population is for the coal mines 39.42 (surface workers) 25.54 (underground workers) and for the coloured/metal mines 42.05 (surface workers) and 30.02 (underground workers).The main causes of the lowered EWL of the underground workers were industrial accidents and pneumoconiosis which indicates that safety measures need to be increased and working conditions improved to protect underground workers.     

期望寿命及健康寿命应用分析

目的　对居民期望寿命和健康寿命的应用进行分析。　方法　采用宁波市城乡 2 0 0 0年居民病伤死因年报表和 2 0 0 1年宁波市城市居民慢性病调查数据 ,分析全死因、去死因期望寿命及健康寿命。　结果　全死因、去死因期望寿命分布均表现为女性高于男性 ,城市高于农村。宁波市 35岁以上城市居民不健康寿命平均为 9.2 1岁 ,占期望寿命的比例各年龄组从 4 3.4 3%到 6 9.88%不等 ,随年龄增长比例逐渐下降。各年龄组健康寿命女性均高于男性 ,平均高 3.0 8岁。　结论　健康寿命是评价人群健康状况的有用指标     

Not all built the same? A comparative study of electoral systems and population health

Much literature depicts a worldwide democratic advantage in population health. However, less research compares health outcomes in the different kinds of democracy or autocracy. In an examination of 179 countries as they existed between 1975 and 2012, advantages in life expectancy and infant health appear most reliably for democracies that include the principle of proportional representation in their electoral rules. Compared to closed autocracies, they had up to 12 or more years of life expectancy on average, 75% less infant mortality, and double the savings in overall mortality for most other age groups. Majoritarian democracies, in contrast, did not experience longitudinal improvements in health relative to closed autocracies. Instead their population health appeared to be on par with or even superseded by competitive autocracies in most models. Findings suggest that the principle of proportional representation may be good for health at the national level. Implications and limitations are discussed.     

中国预期寿命变动的地区差异及其社会经济影响因素:1981—2010

利用最近四期人口普查数据估算的分省预期寿命及相应年份的社会经济统计资料,分析改革开放以来不同省份人口预期寿命之间的地区差异及其历时变动情况,并通过拟合针对面板数据的随机效应模型考察影响人口预期寿命地区差异的社会经济因素。结果研究发现,中国不同地区人口预期寿命差距明显,这一差距在1990—2010年总体上经历了先升后降的变动过程。面板数据模型分析结果显示,经济发展水平和增长速度、收入不平等程度以及教育和卫生基础资源状况是导致不同地区人口预期寿命差异的重要影响因素。     

现时寿命表的编制与展望

本文综述了完全现时寿命表和简略现时寿命表的常用编制方法,并在比较分析的基础之上,指出了诸方法各自的优缺点,最后指出,编制寿命的关键在于如何将中心死亡率nmx按概率调整为nqx,但众多方法所得结果差异不大,因此,不妨采用较易理解,计算简便的方法,以利实际推广使用。     

Infant mortality in the Flemish Region of Belgium 1999-2008: a time-to-event analysis

Background

When calculating life expectancy, it is usually assumed that deaths are uniformly distributed within each of the age intervals. As most of the infant deaths are neonatal deaths, this calls for a better assessment for that age group.

Methods

The Flemish unified death and birth certificates database for all calendar years between 1999 and 2008 was used. A Kaplan-Meier survival analysis on a yearly basis was performed to assess the mean time-to-event and to compare survival curves between both genders.

Results

Over the last years, a slight though not steady decrease of the infant mortality rate is observed. In 2008, the probability among live births of dying before their first anniversary is 4.6‰ in boys and 3.5‰ in girls. The large majority (about 85%) of these have died in their year of birth. The mean survival time of deaths in their year of birth was found to centre around 1 month (about 30 days), which results in a ''mean proportion of the calendar year lived'' (k1) close to 0.09. Among those who died in the year after their year of birth yet before their first anniversary, no such concentration in time of the deaths is observed. Differences between the gender groups are small and generally not statistically significant.

Conclusion

Statistics Belgium, the federal statistics office, imputes a value for k1 equal to 0.1 for infant deaths in their year of birth when calculating life expectancy. Our data fully support this value. We think such refinement is generally feasible in calculating life expectancy.     

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。     

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6–29.6/1,000 live births: range in income inequality: 12.7–27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P<.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions. Data collection and initial analyses for this project were supported in part by an Investigator Award in Health Policy Research from The Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by The Robert Wood Johnson Foundation.