目的:评估婚姻状况对安达卢西亚糖尿病(DM)死亡率的社会和性别不平等的影响。
方法:使用安达卢西亚纵向人口数据库进行了一项横断面研究。对2002年至2013年的DM死亡进行了教育水平和婚姻状况分析。使用泊松回归模型计算年龄调整率(AAR)和死亡率比率(MRR),控制几个社会和人口变量。通过在模型中引入相互作用项来评估婚姻状况对教育水平与DM死亡率之间关系的影响。对男性和女性分别进行所有分析。
结果:在纳入研究的4,229,791人中,有18,158例DM死亡(10,635名女性和7,523名男性)。随着教育水平的下降,死亡风险增加。婚姻状况在每个性别中以不同的方式改变了DM死亡率的社会不平等。受教育程度最低的丧偶和分居/离婚妇女的MRR最高,分别为5,1(95CI:3,6-7,3)和5,6(95%CI:3,6-8,5),而单身男人的MRR最高,3,1(95CI:2,7-3,6)。
结论:教育水平是决定男女糖尿病死亡率的关键因素,与女性更相关,而婚姻状况在男性中也起着突出的作用。我们的结果表明,为了解决DM死亡率的不平等,当前对个人因素和自我保健的关注应扩展到对家庭的干预,社区,和最接近病人的社会环境。
OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia.
METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women.
RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6).
CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.