Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management
Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management
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DOI：
10.3399/bjgp11x572454
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发表时间：
2011-05-01
影响因子：
5.9
通讯作者：
Robson, John
中科院分区：
文献类型：
--
作者：
Mathur, Rohini;Hull, Sally A.;Robson, John
背景：多病在初级保健人群中很常见。在心血管疾病方面，认识到不同种族在疾病流行和风险因素管理方面的重要差异。目的：探讨心血管多病的人群负担和不同种族可改变危险因素的管理。设计和设置：在东伦敦的塔哈姆莱茨、城市、哈克尼和纽汉的初级保健信托机构的一般做法的横断面研究（148/151），总人口为843 720。方法：使用MIQUEST从5个心血管病例中提取患者资料。采用Logistic回归分析检验不同民族的多重发病风险，以及不同民族和心血管多重发病负担对危险因素的控制。结果：在至少有一种心血管疾病的患者中，心血管多病的粗患病率为34%。非白种人比白种人更有可能出现多种疾病，南亚人的校正比值比为2.04(95%可信区间[CI] = 1.94至2.15)，黑人的校正比值比为1.23 （95% CI = 1.18至1.29）。多病患者的血压、胆固醇和糖化血红蛋白（HbA1c）达标率高于单病患者。在胆固醇和血压方面，南亚患者比白人和黑人患者控制得更好。对于HbA1c水平，随着发病率负担的增加，白人患者比其他群体具有优势。结论：多种疾病的负担因民族而异。随着心血管多病水平的提高，风险因素管理得到改善，但种族之间的临床重要差异仍然存在，并导致健康不平等。
Background:Multimorbidity is common in primary care populations. Within cardiovascular disease, important differences in disease prevalence and risk factor management by ethnicity are recognised.Aim:To examine the population burden of cardiovascular multimorbidity and the management of modifiable risk factors by ethnicity.Design and setting:Cross-sectional study of general practices (148/151) in the east London primary care trusts of Tower Hamlets, City and Hackney, and Newham, with a total population size of 843 720.Method:Using MIQUEST, patient data were extracted from five cardiovascular registers. Logistic regression analysis was used to examine the risk of being multimorbid by ethnic group, and the control of risk factors by ethnicity and burden of cardiovascular multimorbidity.Results:The crude prevalence of cardiovascular multimorbidity among patients with at least one cardiovascular condition was 34 %. People of non-white ethnicity are more likely to be multimorbid than groups of white ethnicity, with adjusted odds ratios of 2.04 (95 % confidence interval [CI] = 1.94 to 2.15) for South Asians and 1.23 (95 % CI = 1.18 to 1.29) for groups of black ethnicity. Achievement of targets for blood pressure, cholesterol, and glycated haemoglobin (HbA1c) was higher for patients who were multimorbid than unimorbid. For cholesterol and blood pressure, South Asian patients achieved better control than those of white and black ethnicity. For HbA1c levels, patients of white ethnicity had an advantage over other groups as the morbidity burden increased.Conclusion:The burden of multiple disease varies by ethnicity. Risk factor management improves with increasing levels of cardiovascular multimorbidity, but clinically important differences by ethnicity remain and contribute to health inequalities.