Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study
Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study
复制标题
DOI：
10.1007/s10654-013-9847-2
复制
发表时间：
2013-10-01
影响因子：
13.6
通讯作者：
Verschuren, W. M. Monique
中科院分区：
文献类型：
--
作者：
Kershaw, Kiarri N.;Droomers, Mariel;Verschuren, W. M. Monique
量化不同的可改变的行为和生物风险因素对冠心病（CHD）社会经济差异的影响可能有助于提供有针对性的人群特异性策略，以减少疾病的不平等分布。以前的研究使用的分析方法限制了我们解开这些危险因素对CHD差异的相对贡献的能力。本研究的目的是同时评估多个危险因素对低教育对冠心病事件影响的中介作用。分析基于15，067名荷兰慢性病风险因素监测项目的参与者，年龄在20-65岁之间，1994-1997年进行了检查，并对事件进行了随访，直至2008年1月1日。路径分析用于量化和测试行为（目前吸烟，大量饮酒，不良饮食和缺乏体力活动）和生物学（肥胖，高血压，糖尿病和高胆固醇血症）风险因素对低教育程度-CHD关联的介导作用。行为和生物学危险因素占低教育程度冠心病事件关联的56.6%（95%CI 42.6- 70.8%）。吸烟是最强的中介因素，占相关性的27.3%（95%CI 17.7- 37.4%），其次是肥胖（10.2%; 95%CI 4.5- 16.1%）、缺乏运动（6.3%; 95%CI 2.7- 10.0%）和高血压（5.3%; 95%CI：2.8- 8.0%）。总之，在荷兰队列研究中，低教育水平和冠心病事件之间的关系主要是由传统的行为和生物危险因素介导的。解决戒烟、血压和体重管理以及体力活动的障碍可能是消除冠心病社会经济不平等的最有效方法。
Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20-65 years examined 1994-1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6 % (95 % CI 42.6-70.8 %) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3 % (95 % CI 17.7-37.4 %) of the association, followed by obesity (10.2 %; 95 % CI 4.5-16.1 %), physical inactivity (6.3 %; 95 % CI 2.7-10.0 %), and hypertension (5.3 %; 95 % CI: 2.8-8.0 %). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD.