Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971-2002
Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971-2002
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DOI：
10.1001/archinte.166.21.2348
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发表时间：
2006-11-27
影响因子：
--
通讯作者：
Beckles, Gloria L. A.
中科院分区：
文献类型：
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作者：
Kanjilal, Sanjat;Gregg, Edward W.;Beckles, Gloria L. A.
背景：过去公认的与年收入和教育水平有关的心血管疾病(CVD)危险因素的差异在近几十年里是缩小、持续还是恶化，目前尚不清楚。本研究的目的是根据美国成年人的年收入和教育水平来检验31年来美国成年人心血管疾病危险因素的趋势。方法：使用四项横断面全国性调查：全国健康和营养检查调查I(1971-1974)、II(1976-1980)、III(1988-1994)和1999-2002。主要观察指标是高胆固醇(=240 mg/dL[>；=6.2 mmol/L])、高血压(140/90 mm Hg)、吸烟和糖尿病的患病率。结果：1971至2002年间，除糖尿病外，所有收入和受教育组的心血管疾病危险因素的患病率均有所下降，但在过去10年中，与收入和教育相关的心血管疾病危险因素的差异几乎没有减少，几乎没有改善。在所有收入和受教育群体中，高血压患病率下降了约一半，1971-1974年为30.3%至40.6%，1999-2002年为16.4%，最低收入四分位数和高中以下教育程度的人群降幅最大(分别为18.0和15.9个百分点)。所有人群的高胆固醇患病率也都有所下降，1999年为28.8%至32.4%，19711974至2002年为15.3%至22.0%，最高收入人群的降幅最大(15.9%)。与教育和收入有关的吸烟差距显著扩大，因为高收入和受教育程度的人的吸烟率大幅下降(从1971-1974年的约33%下降到1999-2002年的约14%-17%)，但低收入和受教育程度的人的吸烟率仅略有下降(约下降6个百分点)。糖尿病患病率在低收入和低教育人群中增加最多。结论：尽管在降低美国人口心血管疾病危险因素方面取得了普遍成功，但并不是所有社会阶层都平等受益，改善可能已经放缓。与教育和收入相关的差距因吸烟而恶化，糖尿病患病率的增加主要发生在社会经济地位较低的人中。糖尿病预防和吸烟预防和戒烟计划需要专门针对低收入和受教育程度较低的人。
Background: It is unknown whether the previously recognized disparities in cardiovascular disease (CVD) risk factors related to annual income and educational level have diminished, persisted, or worsened in recent decades. The objective of this study was to examine 31-year trends in CVD risk factors by annual income and educational levels among US adults.Methods: Four cross-sectional national surveys were used: National Health and Nutrition Examination Survey I (1971-1974), II (1976-1980), III (1988-1994), and 1999-2002. The main outcome measure was prevalence of high cholesterol (>= 240 mg/ dL [>= 6.2 mmol/L]), high blood pressure (140/90 mm Hg), smoking, and diabetes mellitus.Results: Between 1971 and 2002, the prevalence of all CVD risk factors, except diabetes, decreased in all income and education groups, but there has been little reduction in income- and education-related disparities in CVD risk factors and few improvements during the past 10 years. The prevalence of high blood pressure declined by about half in all income and education groups, ranging from 30.3% to 40.6% in 1971-1974 and 16.4% in 1999-2002, with the greatest reduction among those in the lowest income quartile and those with less than a high school education (18.0 and 15.9 percentage points, respectively). High cholesterol prevalence also declined in all groups and ranged from 28.8% to 32.4% in 19711974 and 15.3% to 22.0% in 1999-2002, with the largest decline ( 15.9 percentage points) among people with the highest incomes. Education- and income- related disparities in smoking widened considerably, because there were large declines in smoking prevalence among people with high incomes and education ( from about 33% in 1971-1974 to about 14%-17% in 1999-2002) but only marginal reductions among those with low incomes and education ( about 6-percentage point decline). Diabetes prevalence increased most among persons with low incomes and education.Conclusions: Despite the general success in reducing CVD risk factors in the US population, not all segments of society are benefiting equally and improvements may have slowed. Education- and income- related disparities have worsened for smoking, and increases in diabetes prevalence have occurred primarily among persons with a lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target persons of lower income and education.