未经评估:健康的社会决定因素(SDOH)产生了广泛的预期寿命(LE)差异。在中国,从空间角度来看,发现有限的文献报道了连续一段时间在生态水平上SDOH和LE之间的关联。本研究旨在确定存在,量化大小,并解释了中国SDOH和LE之间的关联。
UNASSIGNED:省级LE是根据2005-2020年中国国家死亡率监测系统的死亡率记录估算的。空间面板Durbin模型用于研究LE相关的SDOH代理。引入空间溢出效应来解释SDOH在长期和短期对LE差异的直接和间接影响。
未经批准:全国,从2005年到2020年,LE从73.1年(95%置信区间(CI):71.3,74.4年)增加到77.7年(95CI:76.5,78.7年)。观察到LE的空间分布不均,在沿海地区具有高-高聚集性,在西部地区具有低-低聚集性。本地,据估计,SDOH代理与LE的增加有统计学意义,包括国内生产总值(系数:0.02,95CI:0.00,0.03),基尼系数(系数:2.35,95CI:1.82,2.88),医疗机构床位数(系数:0.02,95CI:0.00,0.05)和常住人口自然增长率(系数:0.02,95CI:0.01,0.02)。LE相关SDOH代理在长期和短期的直接和间接效应分解表明,GDP,城镇化率,失业率,受教育程度,基尼系数,医疗机构的床位数量,性别比例,常住人口的总依赖率和自然增长率不仅影响当地的LE,但也对地理邻居产生了空间溢出效应。
未经评估:中国省级存在LE的空间变异。SDOH关于社会经济发展和公平,医疗资源,以及人口特征不仅影响了当地规模的LE差异,而且影响了附近省份之间的LE差异。应考虑到SDOH代理政策的外部性,以在全国范围内促进卫生公平。应巩固基于人口战略的综合方法,以优化支持性社会经济环境,缩小区域差距,以减少健康差距并增加LE。
UNASSIGNED:国家重点研究发展计划(批准号2018YFC1315301);教育部人文社会科学总计划(批准号18YJC790138)。
UNASSIGNED: Social determinants of health (SDOH) produce a broad range of life expectancy (LE) disparities. In China, limited literatures were found to report association between SDOH and LE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between SDOH and LE in China.
UNASSIGNED: Provincial-level LE were estimated from mortality records during 2005-2020 from National Mortality Surveillance System in China. A spatial panel Durbin model was used to investigate LE associated SDOH proxies. Spatial spillover effects were introduced to interpret direct and indirect effects caused by SDOH during long-term and short-term period on LE disparities.
UNASSIGNED: Nationwide, LE increased from 73.1 (95% confidence interval (CI): 71.3, 74.4) years to 77.7 (95%CI: 76.5, 78.7) years from 2005 to 2020. Unequally spatial distribution of LE with High-High clustering in coastal areas and Low-Low clustering in western regions were observed. Locally, it was estimated that SDOH proxies statistically significant related to an increase of LE, including GDP (coefficient: 0.02, 95%CI: 0.00, 0.03), Gini index (coefficient: 2.35, 95%CI: 1.82, 2.88), number of beds in health care institutions (coefficient: 0.02, 95%CI: 0.00, 0.05) and natural growth rate of resident population (coefficient: 0.02, 95%CI: 0.01, 0.02). Direct and indirect effects decomposition during long-term and short-term of LE associated SDOH proxies demonstrated that GDP, urbanization rate, unemployment rate, education attainment, Gini index, number of beds in health care institutions, sex ratio, gross dependence ratio and natural growth rate of resident population not only affected local LE, but also exerted spatial spillover effects towards geographical neighbors.
UNASSIGNED: Spatial variations of LE existed at provincial-level in China. SDOH regarding socioeconomic development and equity, healthcare resources, as well as population characteristics not only affected LE disparities at local scale but also among nearby provinces. Externalities of policy of those SDOH proxies should be took into consideration to promote health equity nationally. Comprehensive approaches on the basis of population strategy should be consolidated to optimize supportive socioeconomic environment and narrow the regional gap to reduce health disparities and increase LE.
UNASSIGNED: National Key Research & Development Program of China (Grant No.2018YFC1315301); Ministry of Education of China Humanities and Social Science General Program (Grant No.18YJC790138).