PNAS:美国和哥斯达黎加的死亡率与社会经济地位

摘要 : 美国加州大学伯克利分校科研人员报告说，死亡率随着社会经济地位(SES)而变化的现象在美国远远胜于哥斯达黎加。

美国加州大学伯克利分校科研人员报告说，死亡率随着社会经济地位(SES)而变化的现象在美国远远胜于哥斯达黎加。哥斯达黎加的预期寿命超过了美国大约1年，尽管哥斯达黎加的人均gdp不到美国的1/4。 Luis Rosero-Bixby 和 William Dow比较了美国和哥斯达黎加的死亡率和健康风险因素，从而发现两个国家的预期寿命差异的原因。最明显的差异是美国的死亡率与社会经济地位(SES)之间的相关性强于哥斯达黎加。当两国的人口都被分成社会经济地位(SES)四分位数的时候，美国的最高的四分位数比哥斯达黎加的最高四分位数的死亡率更低，但是美国的最低的四分位数比哥斯达黎加的最低的四分位数的死亡率更高。美国的这种死亡率和社会经济地位的陡峭的不平等在9个死因类别中都被观察到了。这组作者还观察到了社会经济地位(SES)和几个健康风险因素之间的相关性，诸如缺乏健康保险、吸烟、肥胖、不受控制的高血糖以及高血压。这组作者说，这些相关性在美国比在哥斯达黎加更强，这有可能解释美国的死亡率随着社会经济地位(SES)的陡峭变化。

原文链接：

Exploring why Costa Rica outperforms the United States in Life expectancy: A tale of two inequality grADIents

原文摘要：

Mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the United States. This comparison simultaneously shows the potential for substantially lowering mortality in other middle-income countries and highlights the United States’ poor health performance. The United States’ underperformance is strongly linked to its much steeper socioeconomic (SES) gradients in health. Although the highest SES quartile in the United States has better mortality than the highest quartile in Costa Rica, US mortality in its lowest quartile is markedly worse than in Costa Rica’s lowest quartile, providing powerful evidence that the US health inequality patterns are not inevitable. High SES-mortality gradients in the United States are apparent in all broad cause-of-death groups, but Costa Rica’s overall mortality advantage can be explained largely by two causes of death: lung cancer and heart disease. Lung cancer mortality in the United States is four times higher among men and six times higher among women compared with Costa Rica. Mortality by heart disease is 54% and 12% higher in the United States than in Costa Rica for men and women, respectively. SES gradients for heart disease and diabetes mortality are also much steeper in the United States. These patterns may be partly explained by much steeper SES gradients in the United States compared with Costa Rica for behavioral and medical risk factors such as smoking, obesity, lack of health insurance, and uncontrolled dysglycemia and hypertension.

doi: 10.1073/PNAS.1521917112

作者：Luis Rosero-Bixby和

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