Socioeconomic inequalities in cardiovascular disease mortality - An international study
Socioeconomic inequalities in cardiovascular disease mortality - An international study
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DOI：
10.1053/euhj.1999.1990
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发表时间：
2000-07-01
影响因子：
39.3
通讯作者：
Groenhof, F
中科院分区：
文献类型：
--
作者：
Mackenbach, JP;Cavelaars, AEJM;Groenhof, F
背景：许多国家报告了不同社会经济群体在心血管疾病死亡率和危险因素方面的差异。我们对美国和西欧国家的这些不平等现象进行了比较分析。分析的目的是(1)比较国家之间心血管疾病死亡率不平等的大小，(2)探索心血管危险因素对解释心血管疾病死亡率不平等的国家之间差异的可能贡献。数据和方法：缺血性心脏病、脑血管疾病和心血管疾病总死亡率的职业类别和/或教育水平数据来自全国纵向或非关联横断面研究。按职业类别和/或教育水平分列的吸烟、饮酒、超重和不经常食用新鲜蔬菜的数据来自全国健康访谈或多目的调查以及欧洲联盟的欧洲晴雨表调查。年龄调整死亡率与年龄调整行为危险因素的比值比相关。结果在所有国家中，低职业等级或低教育水平人群的心血管疾病死亡率较高。在西欧，南北梯度是明显的，相对和绝对不平等在北方比在南方更大。对于缺血性心脏病，但不包括脑血管疾病，可以看到更明显的南北梯度，南欧存在一些“反向”不平等。美国在大多数指标上都处于中间位置。心血管疾病死亡率的不平等与某些风险因素的不平等有关，特别是吸烟和过度饮酒。在大多数工业化国家，心血管疾病死亡率的社会经济不平等是一个主要的公共卫生问题。缩小低社会经济群体和高社会经济群体之间的差距为降低心血管疾病死亡率提供了巨大的潜力。在社会经济地位较低的群体中制定减少行为风险因素的有效方法应是预防心血管疾病的首要任务。[J] .中华心血管病杂志，2000;21(2):1- 4。
Background Differences between socioeconomic groups in mortality from and risk factors for cardiovascular diseases have been reported in many countries. We have made a comparative analysis of these inequalities in the United States and ii western European countries. The aims of the analysis were (1) to compare the size of inequalities in cardiovascular disease mortality between countries, and (2) to explore the possible contribution of cardiovascular risk factors to the explanation of between-country differences in inequalities in cardiovascular disease mortality.Data and Methods Data on ischaemic heart disease, cerebrovascular disease and total cardiovascular disease mortality by occupational class and/or educational level were obtained from national longitudinal or unlinked cross-sectional studies. Data on smoking, alcohol consumption, overweight and infrequent consumption of fresh vegetables by occupational class and/or educational level were obtained from national health interview or multipurpose surveys and from the European Union's Eurobarometer survey. Age-adjusted rate ratios for mortality were correlated with age-adjusted odds ratios for the behavioural risk factors.Results In all countries mortality from cardiovascular diseases is higher among persons with lower occupational class or lower educational level. Within western Europe, a north-south gradient is apparent, with relative and absolute inequalities being larger in the north than in the south. For ischaemic heart disease, but not for cerebrovascular disease, an even more striking north-south gradient is seen, with some 'reverse' inequalities in southern Europe. The United States occupy intermediate positions on most indicators. Inequalities in cardiovascular disease mortality are associated with inequalities in some risk factors, especially cigarette smoking and excessive alcohol consumption.Conclusions Socioeconomic inequalities in cardiovascular disease mortality are a major public health problem in most industrialized countries. Closing the gap between low and high socioeconomic groups offers great potential for reducing cardiovascular disease mortality. Developing effective methods of behavioural risk factor reduction in the lower socioeconomic groups should be a top priority in cardiovascular disease prevention. (Eur Heart J 2000; 21: 1141-1151) (C) 2000 The European Society of Cardiology.