Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project

作者：Wenyao Peng, Siqi Lin, Bowang Chen, Xueke Bai, Chaoqun Wu, Xiaoyan Zhang, Yang Yang, Jianlan Cui, Wei Xu, Lijuan Song, Hao Yang, Wenyan He, Yan Zhang, Xi Li, Jiapeng Lu · 发表于：The Lancet Public Health · 年份：2024 · DOI：10.1016/s2468-2667(24)00154-3 · 被引用次数：11 · 研究领域：Health disparities and outcomes、Chronic Disease Management Strategies、Cardiovascular Health and Risk Factors

BACKGROUND: Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality. METHODS: In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators. FINDINGS: Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with hig...