Beyond the Methods: Economic Stability and Cardiovascular Health.
Beyond the Methods: Economic Stability and Cardiovascular Health.
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超越方法：经济稳定和心血管健康。
DOI：
10.1161/circoutcomes.124.010823
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Sanchez,EduardoJ
中科院分区：
文献类型：
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作者：
Dixon,DebraD;Sanchez,EduardoJ
Brownell等人3利用国家健康和营养检查调查，在收入不平等的背景下，研究了1988年至2018年美国CVH的趋势。利用当代贫困阈值，使用贫困收入比比较收入不平等，并根据汇总队列方程计算的主要不良心血管事件或死亡的10年风险来确定CVH。他们报告CVH随着时间的推移有所改善；然而，这一福利仅限于收入最高的两类人。此外，利用新的股权指标提供了证据，证明CVH的收入不平等实际上在这30年期间恶化了。尽管并非出乎意料，但这些发现尖锐地提出了几个关键点：(1)必须在总体趋势中评估不平等；(2)应考虑社会对减少不平等的重视；(3)公平指标可用于根据最佳做法对不平等进行定量评估；(4)公平指标可能有助于衡量风险的区域差异，解决对不平等的厌恶，评估额外的健康结果。并评估干预措施对健康和不平等的影响。不平等现象继续存在，这是结构性种族主义的直接结果，这种种族主义维持着权力和特权的差别分配，这种分配近似于健康的社会驱动因素（SDOH）。4 . 2019冠状病毒病大流行暴露了长期存在的卫生不平等现象，凸显了政策对卫生结果的影响。从划红线的历史做法（这种做法在面对居家指令时造成了恶劣的住房条件）到缺乏获得医疗保险和保健的机会，各种政策使健康方面的不平等现象永久化并继续加剧。因此，为了消除心血管疾病的差异，必须解决SDOH，而不仅仅是收入和结构性种族主义问题。Brownell等人使用的公平指标包含了一个不公平厌恶参数，该参数试图解决这样一个问题：社会重视解决不平等的程度有多高？这是一个需要考虑的关键问题。现实情况是，答案并不是一成不变的，而是根据被问的对象、涉及的健康措施、问的地点、占主导地位的政治意识形态等因素而有所不同。例如，心血管疾病的许多差异在南部和东南部最为明显，在那里，奴隶制的残余、吉姆·克劳法和当前的健康政治决定因素使解决健康不平等问题变得不重要和贬值，例如，缓慢或没有扩大医疗补助的州集中在南部和东南部。
Brownell et al3 used the National Health and Nutrition Examination Survey to examine US trends in CVH from 1988 to 2018 within the context of income inequities. Income inequities were compared using poverty-toincome ratios utilizing contemporary poverty thresholds, and CVH was determined based on 10-year risk of major adverse cardiovascular events or death as calculated from the pooled cohort equations. They report an improvement in CVH over time; however, this benefit was limited to those in the 2 highest income categories. Additionally, utilization of novel equity metrics provides evidence that income inequities in CVH have, in fact, worsened over this 30-year period. Although not unexpected, these findings poignantly draw out several key points:(1) it is imperative to assess for inequities within overall trends,(2) consideration should be given to the value that society places on reducing inequities,(3) equity metrics can be used to provide a quantitative assessment of inequity in accordance with best practices, and (4) equity metrics may help to measure regional variations in risk, address aversion to inequity, evaluate additional health outcomes, and assess the impact of interventions on both health and inequity. Inequities persist as a direct result of structural racism which maintains the differential distribution of power and privilege approximated by social drivers of health (SDOH). 4 The COVID-19 pandemic illuminated longstanding health inequities and highlighted the impact of policies on health outcomes. Policies ranging from the historical practice of redlining, which created the substrate for poor housing conditions in the face of stayat-home directives, to the lack of access to health care coverage and health care, perpetuate, and continue to exacerbate inequities in health. Thus, SDOH, not only income, and structural racism must be addressed to eliminate disparities in CVD. The equity metrics used by Brownell et al incorporate an inequity aversion parameter which attempts to address the question: how much does society value addressing inequity? This is a critical question to consider. The reality is that the answer is not constant and varies based on who is asked, what health measure is in question, where one asks, and what political ideologies prevail, among other factors. For example, many disparities in CVD are most pronounced in the south and southeast, where the vestiges of slavery, Jim Crow laws, and current political determinants of health deprioritize and devalue addressing health inequities, for instance, states that were slow to or have not expanded Medicaid are concentrated in the south and southeast.