Explaining population trends in cardiovascular risk: A comparative analysis of health transitions in South Africa and England

本研究使用现有数据来确定南非与英国相比最近健康转变的驱动因素。非传染性疾病对健康造成的全球负担正在增加。特别是心血管疾病是全球死亡的主要原因，往往与许多主要非传染性疾病具有共同特征。也就是说，它们往往随着年龄的增长而增加，并受到饮食、运动和吸烟等行为因素的影响。心血管疾病的危险因素通常在人口调查中测量，从而提供了研究健康转变的机会。了解那些没有遵循预期路径的国家（如南非）与那些示范“流行病学转变”模式的国家（如英国）的卫生转变的驱动因素，可以产生关于在何处可以最好地分配资源以减轻疾病负担的知识。在中等收入国家南非，心血管疾病是仅次于艾滋病毒/艾滋病和结核病的第二大死因。此外，许多非传染性疾病（如心血管疾病）的已知危险因素非常普遍。高血压的发病率很高，最近的估计表明，超过40%的成年人患有高血压。在南非，大约60%的15岁以上女性和30%的15岁以上男性超重。此外，过量饮酒是许多慢性疾病的一个危险因素，在15岁及以上的男子中，有30%以上的人在30天内进行了大量的间歇性饮酒。尽管如此，艾滋病毒/艾滋病等传染病仍然是导致死亡的主要原因，尽管许多艾滋病毒/艾滋病和结核病患者也患有非传染性疾病。相比之下，在像英国这样的高收入国家，心血管疾病等非传染性疾病自20世纪中期以来一直是导致死亡的主要原因。然而，近几十年来，由于预防和治疗的加强，心血管疾病和高血压等危险因素一直在下降。疾病负担变化的主要驱动因素可归因于老龄化、生活水平提高、城市化、生活方式改变和传染病减少等因素。总之，这些变化通常被称为流行病学转变。然而，最近的研究质疑流行病学过渡理论是否准确地描述了许多低收入和中等收入国家的经历，或者实际上是英国等高收入国家的经历。此外，很少有研究经验性地检验人口、行为、健康和经济因素对疾病负担和风险趋势的相对贡献，特别是在非洲大陆。此外，许多社会和环境因素在本研究中被忽视。为了解决这些差距，我们的研究将使用从南非近20年的调查中得出的心血管疾病风险的人口测量数据，以检查人口、行为、环境、医疗、社会和其他因素是否以及在多大程度上影响了最近的健康趋势和转变。我们将把这些趋势与同一时期在英国发生的趋势进行比较。因此，本分析旨在阐明一个被认为仍在向慢性病“过渡”但继续具有高传染病负担的国家（南非）与一个被认为已经根据流行病学过渡理论过渡的国家（英国）的健康过渡的驱动因素。该分析将采用汇集的横断面数据的建模技术来检查各种因素如何解释来自南非和英国的代表性人群样本中心血管疾病风险随时间的变化。这一分析的结果可能有助于确定导致南非和英国心血管疾病风险近期变化的一些主要因素。这些信息可用于查明社会政策和服务等潜在干预领域，从而帮助确定政府和非政府行动的优先事项，以控制心血管疾病流行和改善健康。

This study uses existing data to identify drivers of recent health transitions in South Africa compared to England. The global burden of non-communicable diseases (NCDs) on health is increasing. Cardiovascular diseases (CVD) in particular are the leading causes of death globally and often share characteristics with many major NCDs. Namely, they tend to increase with age and are influenced by behavioural factors such as diet, exercise and smoking. Risk factors for CVD are routinely measured in population surveys and thus provide an opportunity to study health transitions. Understanding the drivers of health transitions in countries that have not followed expected paths (eg, South Africa) compared to those that exemplified models of 'epidemiologic transition' (eg, England) can generate knowledge on where resources may best be directed to reduce the burden of disease.In the middle-income country of South Africa, CVD is the second leading cause of death after HIV/AIDS and tuberculosis (TB). Moreover, many of the known risk factors for NCDs like CVD are highly prevalent. Rates of hypertension are high, with recent estimates suggesting that over 40% of adults have high blood pressure. Around 60% of women and 30% of men over 15 are overweight in South Africa. In addition, excessive alcohol consumption, a risk factor for many chronic diseases, is high, with over 30% of men aged 15 and older having engaged in heavy episodic drinking within a 30-day period. Nevertheless, infectious diseases such as HIV/AIDS remain the leading cause of death, though many with HIV/AIDS and TB also have NCDs.In high-income countries like England, by contrast, NCDs such as CVD have been the leading causes of death since the mid-1900s. However, CVD and risk factors such as hypertension have been declining in recent decades due to increased prevention and treatment. The major drivers of change in disease burden have been attributed to factors including ageing, improved living standards, urbanisation, lifestyle change, and reduced infectious disease. Together, these changes are often referred to as the epidemiologic transition. However, recent research has questioned whether epidemiologic transition theory accurately describes the experience of many low- and middle-income countries or, in fact, of high-income nations such as England. Furthermore, few studies have empirically tested the relative contributions of demographic, behavioural, health and economic factors to trends in disease burden and risk, particularly on the African continent. In addition, many social and environmental factors are overlooked in this research. To address these gaps, our study will use population measurements of CVD risk derived from surveys in South Africa over nearly 20 years in order to examine whether and to what extent demographic, behavioural, environmental, medical, social and other factors contribute to recent health trends and transitions. We will compare these trends to those occurring in England over the same time period. Thus, this analysis seeks to illuminate the drivers of health transitions in a country which is assumed to still be 'transitioning' to a chronic disease profile but which continues to have a high infectious disease burden (South Africa) as compared to a country which is assumed to have already transitioned following epidemiological transition theory (England). The analysis will employ modelling techniques on pooled cross-sectional data to examine how various factors explain the variation in CVD risk over time in representative population samples from South Africa and England. The results of this analysis may help to identify some of the main contributors to recent changes in CVD risk in South Africa and England. Such information can be used to pinpoint potential areas for intervention, such as social policy and services, thereby helping to set priorities for governmental and nongovernmental action to control the CVD epidemic and improve health.