Stewart Ralph A, North Fiona M, Sharples Katrina J, Simes R John, Tonkin Andrew M, White Harvey D
Green Lane Cardiovascular Unit, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand.
N Z Med J. 2008 Feb 15;121(1269):11-23.
Cardiovascular mortality is higher in New Zealand compared to Australia, but reasons for this difference are uncertain. This study describes differences in cardiovascular risk factors and cardiovascular mortality in Australians and New Zealanders with stable coronary artery disease stratified by socioeconomic status.
Socioeconomic status was estimated from the residential area of 5949 Australians and 2784 New Zealanders with a history of myocardial infarction or unstable angina who participated in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study. Socioeconomic and international differences in cardiovascular risk factors, medical treatments, and cardiovascular mortality during a median follow-up period of 7.8 years were evaluated.
Cardiovascular mortality increased as the median residential-area income decreased in both Australia (hazard ratio [HR]/income tertile 1.20, 95% confidence interval [CI] 1.08-1.32) and New Zealand (HR 1.16, 95%CI 1.02-1.31), but was higher in New Zealand across all socioeconomic groups (HR 1.42, 95%CI 1.25-1.61). Obesity, smoking, and a high white blood cell count at baseline were associated with higher cardiovascular mortality and were more common in lower-income areas in both countries. The total:HDL cholesterol ratio was higher in New Zealand, but similar across all socioeconomic groups. In both countries there were socioeconomic gradients in open-label usage of cholesterol-lowering medication, percutaneous coronary intervention, and coronary artery bypass surgery. However, Australians in all socioeconomic groups were more likely than New Zealanders to receive these treatments.
Although there is an important socioeconomic gradient in cardiovascular mortality in both Australia and New Zealand, cardiovascular mortality is higher in New Zealanders than Australians with stable coronary disease from all socioeconomic groups.
与澳大利亚相比，新西兰的心血管疾病死亡率更高，但造成这种差异的原因尚不确定。本研究描述了患有稳定型冠状动脉疾病的澳大利亚人和新西兰人在心血管危险因素和心血管疾病死亡率方面的差异，并按社会经济地位进行了分层。
根据参与缺血性疾病普伐他汀长期干预研究（LIPID研究）的5949名有心肌梗死或不稳定型心绞痛病史的澳大利亚人和2784名新西兰人的居住地区，估算其社会经济地位。评估了在中位随访期7.8年期间，心血管危险因素、医疗治疗和心血管疾病死亡率方面的社会经济差异和国际差异。
在澳大利亚（风险比[HR]/收入三分位数1.20，95%置信区间[CI]1.08 - 1.32）和新西兰（HR 1.16，95%CI 1.02 - 1.31），心血管疾病死亡率均随居住地区收入中位数的降低而增加，但在所有社会经济群体中，新西兰的死亡率更高（HR 1.42，95%CI 1.25 - 1.61）。肥胖、吸烟和基线时白细胞计数高与较高的心血管疾病死亡率相关，且在两国低收入地区更为常见。新西兰的总胆固醇与高密度脂蛋白胆固醇比值更高，但在所有社会经济群体中相似。在两国，在使用降胆固醇药物、经皮冠状动脉介入治疗和冠状动脉搭桥手术的开放标签使用方面都存在社会经济梯度。然而，所有社会经济群体中的澳大利亚人比新西兰人更有可能接受这些治疗。
尽管在澳大利亚和新西兰，心血管疾病死亡率都存在重要的社会经济梯度，但患有稳定型冠状动脉疾病的新西兰人的心血管疾病死亡率高于澳大利亚人，且涵盖所有社会经济群体。
