解释冠心病的社会梯度：比较相对风险和绝对风险方法。
Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches.
作者信息
Lynch John, Davey Smith George, Harper Sam, Bainbridge Kathleen
机构信息
Department Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Canada QC H3A 1A2.
出版信息
J Epidemiol Community Health. 2006 May;60(5):436-41. doi: 10.1136/jech.2005.041350.
STUDY OBJECTIVES
There are contradictory perspectives on the importance of conventional coronary heart disease (CHD) risk factors in explaining population levels and social gradients in CHD. This study examined the contribution of conventional CHD risk factors (smoking, hypertension, dyslipidaemia, and diabetes) to explaining population levels and to absolute and relative social inequalities in CHD. This was investigated in an entire population and by creating a low risk sub-population with no smoking, dyslipidaemia, diabetes, and hypertension to simulate what would happen to relative and social inequalities in CHD if conventional risk factors were removed.
DESIGN, SETTING, AND PARTICIPANTS: Population based study of 2682 eastern Finnish men aged 42, 48, 54, 60 at baseline with 10.5 years average follow up of fatal (ICD9 codes 410-414) and non-fatal (MONICA criteria) CHD events.
MAIN RESULTS
In the whole population, 94.6% of events occurred among men exposed to at least one conventional risk factor, with a PAR of 68%. Adjustment for conventional risk factors reduced relative social inequality by 24%. However, in a low risk population free from conventional risk factors, absolute social inequality reduced by 72%.
CONCLUSIONS
Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk factors explain the vast majority of CHD cases in the population. However, the role of conventional risk factors in explaining relative social inequality was modest. This apparent paradox may arise in populations where inequalities in conventional risk factors between social groups are low, relative to the high levels of conventional risk factors within every social group. If the concern is to reduce the overall population health burden of CHD and the disproportionate population health burden associated with the social inequalities in CHD, then reducing conventional risk factors will do the job.
研究目的
对于传统冠心病（CHD）危险因素在解释冠心病的人群水平和社会梯度方面的重要性，存在相互矛盾的观点。本研究考察了传统冠心病危险因素（吸烟、高血压、血脂异常和糖尿病）在解释人群水平以及冠心病的绝对和相对社会不平等方面的作用。在整个人口中进行了此项研究，并通过创建一个无吸烟、血脂异常、糖尿病和高血压的低风险亚人群，来模拟如果去除传统危险因素，冠心病的相对和社会不平等情况会发生什么变化。
设计、背景和参与者：基于人群的研究，对象为2682名芬兰东部男性，基线年龄分别为42、48、54、60岁，对致命性（国际疾病分类第九版编码410 - 414）和非致命性（莫妮卡标准）冠心病事件进行了平均10.5年的随访。
主要结果
在整个人口中，94.6%的事件发生在暴露于至少一种传统危险因素的男性中，人群归因危险度为68%。对传统危险因素进行调整后，相对社会不平等降低了24%。然而，在一个没有传统危险因素的低风险人群中，绝对社会不平等降低了72%。
结论
传统危险因素解释了冠心病中大部分的绝对社会不平等，因为传统危险因素解释了人群中绝大多数的冠心病病例。然而，传统危险因素在解释相对社会不平等方面的作用较小。这种明显的矛盾可能出现在这样的人群中：相对于每个社会群体内部较高的传统危险因素水平，社会群体之间传统危险因素的不平等程度较低。如果关注的是降低冠心病的总体人群健康负担以及与冠心病社会不平等相关的不成比例的人群健康负担，那么降低传统危险因素将起到作用。
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