挪威中年后期人口的财富与死亡率：一项基于全国登记册的回顾性研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2024-11-08 DOI:10.1016/j.lanepe.2024.101113

Alexi Gugushvili, Øyvind Nicolay Wiborg

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引用次数: 0

摘要

背景近几十年来，我们注意到财富不平等在不断加剧，而许多西方福利民主国家的预期寿命增长速度却在放缓。然而，有关财富与死亡率之间联系的证据却很少。这一领域的研究在方法上的主要局限性在于无法解释个人未观察到的异质性，如人格和遗传因素，这些因素可能会影响个人的财富水平和生存概率。本研究旨在探讨财富如何与中年后期的死亡风险相关联，从而深入了解社会经济地位对健康结果的广泛影响。方法在本研究中，我们使用了挪威全体人口的高质量财富和死亡率登记数据，挪威是世界上最先进的福利国家之一，收入不平等程度较低，但财富分配极不均衡。我们通过探讨 37-38 岁时的财富是否能预测 62 岁之前的死亡率，解决了以往研究在方法上的一些主要限制因素。研究结果Kaplan-Meier 生存分析和 Cox 比例危险回归结果均表明，即使考虑了个人的观察和非观察特征，财富仍是预测死亡率的重要因素，男性的危险比为 2.39 [95% 置信区间，CI 2.02，2.83]，女性的倒累积密度等级系数为 1.74 [95% CI 1.39，2.16]。处境最不利的群体是财富分布较低端的无伴侣男性和女性。双胞胎分析与普通人群的研究结果一致，表明财富对死亡率的影响不会受到遗传或共同家庭背景因素的干扰。我们的研究结果表明，财富是预测死亡率的一个重要因素，即使在一个提供全面医疗保健的先进福利国家也是如此，这凸显了解决财富分配不均以改善人口健康状况的必要性。

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Wealth and mortality among late-middle-aged individuals in Norway: a nationwide register-based retrospective study

Background

In recent decades, we have observed rising wealth inequality while the pace of growth of life expectancy has slowed in many Western welfare democracies. There is scarce evidence, however, on links between wealth and mortality. The main methodological limitation in this area of scholarship is its inability to account for individuals' unobserved heterogeneity, such as personality and genetic factors, which could potentially affect both their wealth level and survival probabilities. This study aims to explore how wealth is linked to mortality risk in late-middle age, providing insights into the broader implications of socioeconomic status on health outcomes.

Methods

In this study, we use high-quality register data on wealth and mortality for the entire population of Norway, one of the world's most advanced welfare states with a low income inequality level but a highly uneven distribution of wealth. We address some of the main methodological constraints of the previous research by exploring if wealth at the age of 37–38 predicts mortality up to age 62. The research design employed mitigates the problem of unobserved heterogeneity by using sibling and twin fixed-effects models.

Findings

Both Kaplan–Meier survival analyses and the Cox proportional hazard regression results suggest that wealth is an important predictor of mortality even after individuals' observed and unobserved characteristics are accounted for with hazard ratios of 2.39 [95% confidence interval, CI 2.02, 2.83] among men and 1.74 [95% CI 1.39, 2.16] among women for the inverted cumulative density rank coefficients. The most disadvantaged groups are non-partnered men and women at the lower end of wealth distribution. Twin analyses align with the findings for the general population, indicating that wealth's effect on mortality is not confounded by genetic or shared family background factors.

Interpretation

Our findings suggest that wealth is an important predictor of mortality, even in an advanced welfare state with comprehensive healthcare provisions, highlighting the need to address inequalities in wealth distribution to improve population health outcomes.

Funding

The Research Council of Norway.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.