Laaser Ulrich, Breckenkamp Juergen
Section of International Public Health, Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany.
Eur J Public Health. 2006 Apr;16(2):217-22. doi: 10.1093/eurpub/cki062. Epub 2005 Aug 10.
Diagnosis and treatment of the two primary cardiovascular risk factors, hypertension and hypercholesterolaemia, are well established. Nevertheless, according to earlier analyses of representative health questionnaire and examination surveys in 1984, 1988 and 1991, control of risk factors in the sense of normalized values through drug therapy did not improve to any relevant degree in former West Germany. The National Health Survey of 1998 now allows the reconsideration of the hypothesis that medical treatment has been improving and lead to a reduction of risk factor values measured in the population.
Datasets of independent cross-sectional studies in 1984, 1988, 1991 and 1998 with net random sample sizes between 3,458 and 5,335 were analysed for actual (persons with elevated values and persons successfully treated) and population (persons with elevated values) prevalence, awareness of the risk factors under question, treatment coverage (risk factor aware and treated) and effectiveness (risk factor aware, treated and normalized), and the resulting parameters of controlled (successfully treated persons among actual prevalence) and uncontrolled prevalence (persons with elevated values among actual prevalence), respectively. Thresholds chosen were blood pressure values >or=160/95 mmHg for hypertension and values >or=250 mg/dl for hypercholesterolaemia. Regarding medication, the answer of 'one to two times weekly' or more was considered to indicate a relevant drug intake.
For hypertension the population prevalence (population 30-69 years old) increased significantly (P < 0.0001) from 19.6% to 24.0% between 1984 and 1998, whereas the actual prevalence rose less steeply but still significantly (P < 0.0002) from 32.5% to 34.4%. For hypercholesterolaemia the population prevalence stagnated at 37.0% (1998), whereas the actual prevalence was 47.5% in 1998 (39.1% in 1984; P < 0.0001). For hypertension treatment, coverage improved from 45.4% to 63.0%, but treatment effectiveness decreased from 51.7% to 41.3%, both trends being highly significant. For hypercholesterolaemia, awareness increased from 18.3% to 57.6%, but treatment coverage decreased from 33.5% to 15.5%, whereas treatment effectiveness improved from 23.8% to 47.7%, all trends being highly significant (P < 0.0001).
The results do not support the hypothesis that medical care for the large population at cardiovascular risk in (Western) Germany was adequate and successful in the 1980s and 1990s.
高血压和高胆固醇血症这两种主要心血管危险因素的诊断和治疗方法已确立。然而，根据1984年、1988年和1991年具有代表性的健康调查问卷及检查调查的早期分析，在前西德，通过药物治疗使危险因素的值达到正常水平的控制情况并未得到显著改善。1998年的全国健康调查现在可以重新审视关于医疗治疗一直在改善并导致人群中测量的危险因素值降低这一假设。
分析了1984年、1988年、1991年和1998年独立横断面研究的数据集，净随机样本量在3458至5335之间，以确定实际患病率（值升高者和成功治疗者）和人群患病率（值升高者）、对所讨论危险因素的知晓率、治疗覆盖率（知晓并治疗危险因素者）和治疗效果（知晓、治疗且值正常者），以及分别由此得出的控制患病率（实际患病率中成功治疗者）和未控制患病率（实际患病率中值升高者）的参数。所选阈值为高血压收缩压≥160/95 mmHg和高胆固醇血症≥250 mg/dl。关于用药，回答“每周一至两次”或更多被视为表明有相关药物摄入。
对于高血压，1984年至1998年间，人群患病率（30 - 69岁人群）从19.6%显著增加（P < 0.0001）至24.0%，而实际患病率上升幅度较小但仍显著（P < 0.0002），从32.5%升至34.4%。对于高胆固醇血症，人群患病率在1998年停滞在37.0%，而1998年实际患病率为47.5%（1984年为39.1%；P < 0.0001）。对于高血压治疗，覆盖率从45.4%提高到63.0%，但治疗效果从51.7%降至41.3%，这两个趋势均高度显著。对于高胆固醇血症，知晓率从18.3%提高到57.6%，但治疗覆盖率从33.5%降至15.5%，而治疗效果从23.8%提高到47.7%，所有趋势均高度显著（P < 0.0001）。
结果不支持关于20世纪80年代和90年代德国（西部）大量心血管疾病风险人群的医疗保健充足且成功这一假设。
