Inequalities in mortality during and after restructuring of the New
Zealand economy: repeated cohort studies
Tony Blakely, Martin Tobias, June Atkinson. BMJ. Published online Jan 24, 2008.
Abstract
Objectives To determine whether disparities between income and
mortality changed during a period of major structural and
macroeconomic reform and to estimate the changing contribution of
different diseases to these disparities.
Design Repeated cohort studies.
Data sources 1981, 1986, 1991, 1996, and 2001 censuses linked to
mortality data.
Population Total New Zealand population, ages 1-74 years.
Methods Mortality rates standardised for age and ethnicity were
calculated for each census cohort by level of household income.
Standardised rate differences and rate ratios, and slope and relative
indices of inequality (SII and RII), were calculated to measure
disparities on both absolute and relative scales.
Results All cause mortality rates declined over the 25 year study
period in all groups stratified by sex, age, and income, except for
25-44 year olds of both sexes on low incomes among whom there was
little change. In all age groups pooled, relative inequalities
increased from 1981-4 to 1996-9 (RIIs increased from 1.85 (95%
confidence interval 1.67 to 2.04) to 2.54 (2.29 to 2.82) for males
and from 1.54 (1.35 to 1.76) to 2.12 (1.88 to 2.39) for females),
then stabilised in 2001-4 (RIIs of 2.60 (2.34 to 2.89) and 2.18 (1.93
to 2.45), respectively). Absolute inequalities were stable over time,
with a possible fall from 1996-9 to 2001-4. Cardiovascular disease
was the major contributor to the observed disparities between income
and mortality but decreased in importance from 45% in 1981-4 to 33%
in 2001-4 for males and from 50% to 29% for females. The
corresponding contribution of cancer increased from 16% to 22% for
males and from 12% to 25% for females.
Conclusions During and after restructuring of the economy disparities
in mortality between income groups in New Zealand increased in
relative terms (but not in absolute terms), but it is difficult to
confidently draw a causal link with structural reforms. The
contribution of different causes of death to this inequality changed
over time, indicating a need to re-prioritise health policy accordingly.
http://www.bmj.com/cgi/content/full/bmj.39455.596181.25v1
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