Nilunger Louise, Diderichsen Finn, Burström Bo, Ostlin Piroska
Department of Public Health Science, Karolinska Institute, Norrbacka, 171 76 Stockholm, Sweden.
Health Policy. 2004 Feb;67(2):215-24. doi: 10.1016/s0168-8510(03)00122-2.
The aim of this study is to contribute to the emerging field of quantification of Health Impact Assessment (HIA), by analysing how different relative risks affect the burden of disease for various socio-economic groups (SES). Risk analysis, utilising attributable and impact fraction, raises several methodological considerations. The present study illustrates this by measuring the impact of changed distribution levels of smoking on lung cancer, ischemic heart disease (IHD), chronic obstructive lung disorder (COLD) and stroke for the highest and lowest socio-economic groups measured in disability adjusted life years (DALY). The material is based on relative risks obtained from various international studies, smoking prevalence (SP) data and the number of DALY based on data available for Sweden. The results show that if smoking would have been eliminated (attributable fraction, AF), the inequality between the highest and lowest socio-economic groups may decrease by 75% or increase by 21% depending on the size of the relative risk. Assuming the same smoking prevalence for the lowest socio-economic group as for the highest (impact fraction), then the inequality may decrease by 7-26%. Consequently, the size of the relative risk used may have a significant impact, leading to substantial biases and therefore should be taken into serious consideration in HIA.
本研究的目的是通过分析不同的相对风险如何影响各社会经济群体（SES）的疾病负担，为健康影响评估（HIA）量化这一新兴领域做出贡献。利用归因分数和影响分数进行的风险分析引发了若干方法学上的考虑。本研究通过测量吸烟分布水平变化对以残疾调整生命年（DALY）衡量的最高和最低社会经济群体的肺癌、缺血性心脏病（IHD）、慢性阻塞性肺病（COLD）和中风的影响来说明这一点。该材料基于从各项国际研究中获得的相对风险、吸烟率（SP）数据以及基于瑞典可得数据的DALY数量。结果表明，如果消除吸烟（归因分数，AF），最高和最低社会经济群体之间的不平等可能会减少75%，或者根据相对风险的大小增加21%。假设最低社会经济群体的吸烟率与最高群体相同（影响分数），那么不平等可能会减少7 - 26%。因此，所使用的相对风险的大小可能会产生重大影响，导致严重偏差，因此在HIA中应予以认真考虑。
