Anderson Geoffrey M, Bronskill Susan E, Mustard Cameron A, Culyer Anthony, Alter David A, Manuel Douglas G
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, McMurrich Building, 2nd floor, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada.
J Clin Epidemiol. 2005 Aug;58(8):757-62. doi: 10.1016/j.jclinepi.2004.10.020.
To compare and contrast clinical epidemiology and population health perspectives on the role of health care in reducing socioeconomic disparities in health.
A review of concepts outlined in selected articles on population health and clinical epidemiology and a systematic literature search for randomized controlled trials (RCTs) of therapeutic interventions for cardiovascular disease that contained analysis of outcomes by socioeconomic status.
Population health has a focus on health disparities, particularly disparities related to socioeconomic status, and many of its proponents have a pessimistic view of the degree to which health care can reduce these disparities. Clinical epidemiology has a focus on the production of valid evidence on the impact of health care interventions; however, RCTs rarely report the impact of interventions across socioeconomic strata. Both population health and clinical epidemiology share the view that efficacy, effectiveness, and cost-effectiveness are all important in defining the impact of health care on health disparities.
Principles drawn from both population health and clinical epidemiology could be used to provide a clearer picture of the role that health care interventions can have on socioeconomic disparities in health and to identify implications for policy, research, and clinical practice.
比较和对比临床流行病学与人群健康视角下医疗保健在减少健康方面社会经济差异中的作用。
回顾关于人群健康和临床流行病学的选定文章中概述的概念,并对包含按社会经济地位分析结果的心血管疾病治疗干预随机对照试验(RCT)进行系统文献检索。
人群健康关注健康差异,尤其是与社会经济地位相关的差异,其许多支持者对医疗保健能够减少这些差异的程度持悲观看法。临床流行病学关注产生关于医疗保健干预影响的有效证据;然而,随机对照试验很少报告跨社会经济阶层的干预影响。人群健康和临床流行病学都认为,疗效、效果和成本效益在界定医疗保健对健康差异的影响方面都很重要。
从人群健康和临床流行病学中得出的原则可用于更清晰地描绘医疗保健干预对健康方面社会经济差异可能产生的作用,并确定对政策、研究和临床实践的影响。