Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013
Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013
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1969-2013 年美国心血管疾病死亡率的社会经济和种族差异不断扩大
DOI：
10.21106/ijma.44
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发表时间：
2014
影响因子：
--
通讯作者：
Shanita D. Williams
中科院分区：
文献类型：
--
作者：
Gopal K Singh;M. Siahpush;R. Azuine;Shanita D. Williams
目的：本研究调查了 1969 年至 2013 年间美国心血管疾病 (CVD) 死亡率的趋势以及社会经济和种族/民族差异。方法：使用国家生命统计数据和国家纵向死亡率研究来估计随时间推移的 CVD 死亡率的种族/民族以及地区和个人层面的社会经济差异。使用比率和对数线性回归来模拟死亡率趋势和差异。结果：1969 年至 2013 年间，白人的 CVD 死亡率每年下降 2.66%，黑人的 CVD 死亡率每年下降 2.12%。研究期间，心血管疾病死亡率的种族差异和社会经济梯度大幅增加。 2013年，黑人的CVD死亡率比白人高30%，比亚裔/太平洋岛民高113%。与最富裕群体相比，最贫困地区群体的 CVD 死亡率在 1969 年高出 11%，但在 2007-2011 年期间高出 40%。教育、收入和职业与男性和女性的心血管疾病死亡率呈负相关。受教育程度和收入水平较低的男性和女性的 CVD 死亡风险比受教育程度和收入水平较高的男性和女性高 46-76%。从事文书、服务、农业、手工艺、修理、建筑和运输职业以及体力劳动者的男性 CVD 死亡风险比从事行政和管理职业的男性高 30-58%。结论和全球健康影响：心血管疾病死亡率的社会经济和种族差异非常明显，并且随着时间的推移，由于富裕和大多数人群的死亡率下降更快，这种差异不断扩大。 CVD死亡率的差异可能反映了社会环境、吸烟、肥胖、缺乏身体活动等行为风险因素、疾病患病率以及医疗保健获取和治疗方面的不平等。随着许多慢性病危险因素患病率的上升，全球心血管疾病负担预计将进一步增加，特别是在低收入和中等收入国家，这些国家的 CVD 死亡人数占所有 CVD 死亡人数的 80% 以上。
Objectives: This study examined trends and socioeconomic and racial/ethnic disparities in cardiovascular disease (CVD) mortality in the United States between 1969 and 2013. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate racial/ethnic and area- and individual-level socioeconomic disparities in CVD mortality over time. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: Between 1969 and 2013, CVD mortality rates decreased by 2.66% per year for whites and 2.12% for blacks. Racial disparities and socioeconomic gradients in CVD mortality increased substantially during the study period. In 2013, blacks had 30% higher CVD mortality than whites and 113% higher mortality than Asians/Pacific Islanders. Compared to those in the most affluent group, individuals in the most deprived area group had 11% higher CVD mortality in 1969 but 40% higher mortality in 2007-2011. Education, income, and occupation were inversely associated with CVD mortality in both men and women. Men and women with low education and incomes had 46-76% higher CVD mortality risks than their counterparts with high education and income levels. Men in clerical, service, farming, craft, repair, construction, and transport occupations, and manual laborers had 30-58% higher CVD mortality risks than those employed in executive and managerial occupations. Conclusions and Global Health Implications: Socioeconomic and racial disparities in CVD mortality are marked and have increased over time because of faster declines in mortality among the affluent and majority populations. Disparities in CVD mortality may reflect inequalities in the social environment, behavioral risk factors such as smoking, obesity, physical inactivity, disease prevalence, and healthcare access and treatment. With rising prevalence of many chronic disease risk factors, the global burden of cardiovascular diseases is expected to increase further, particularly in low- and middle-income countries where over 80% of all CVD deaths occur.