Atlantis E, Lange K, Wittert G A
Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
Obes Rev. 2009 Sep;10(5):543-53. doi: 10.1111/j.1467-789X.2009.00590.x. Epub 2009 Apr 26.
Trends in chronic diseases provide insights into strategies required to improve population health. The authors determined prevalence and multiple-adjusted population attributable risk (PAR) estimates of chronic diseases because of lifestyle factors among Australian adults between 1989-90 and 2004-5, accounting for demographic factors. Between 1989-90 and 2004-5, prevalence increased for diabetes (3.8-6.0%, P < 0.001) and high cholesterol (11.3-13.9%, P < 0.001), but decreased for high blood pressure (21.4-20.4%, P = 0.003) and cardiovascular disease (CVD, 6.2-5.4%, P < 0.001). Prevalence increased for body mass index (BMI) 25-29.9 (30.3-34.9%, P < 0.001), BMI 30-34.9 (7.4-13.5%, P < 0.001) and BMI 35+ (2.1-5.4%, P < 0.001), but decreased for metabolic equivalent-hours per week (MET-hr/week) 0 (36.8-33.1%, P < 0.001) and current smokers (27.6-24.4%, P < 0.001). Diabetes, high cholesterol and high blood pressure burden increased mostly for 60+ years, lowest income quintiles and high BMI (30-34.9 and 35+). Diabetes and CVD burden increased mostly for MET-hr/week 0. Many chronic disease cases would have been theoretically prevented if adults had no prior exposure to BMI 25-29.9 (PAR 9-17%), BMI 30+ (PAR 1-14%) and MET-hr/week 0 (PAR 6-14%). Reducing exposure to lifestyle hazards across the lifespan is required for reversing the rising burden of chronic diseases. Decreases in CVD and high blood pressure prevalence were likely due to targeted improvements in health care, indicating that more can and should be done.
慢性病趋势为改善人群健康所需策略提供了见解。作者确定了1989 - 1990年至2004 - 2005年间澳大利亚成年人中因生活方式因素导致的慢性病患病率及多因素调整后的人群归因风险（PAR）估计值，并考虑了人口统计学因素。在1989 - 1990年至2004 - 2005年间，糖尿病患病率上升（3.8% - 6.0%，P < 0.001），高胆固醇患病率上升（11.3% - 13.9%，P < 0.001），但高血压患病率下降（21.4% - 20.4%，P = 0.003），心血管疾病（CVD）患病率下降（6.2% - 5.4%，P < 0.001）。体重指数（BMI）在25 - 29.9之间的患病率上升（30.3% - 34.9%，P < 0.001），BMI在30 - 34.9之间的患病率上升（7.4% - 13.5%，P < 0.001），BMI在35及以上的患病率上升（2.1% - 5.4%，P < 0.001），但每周代谢当量小时数（MET - hr/周）为0的患病率下降（36.8% - 33.1%，P < 0.001），当前吸烟者的患病率下降（27.6% - 24.4%，P < 0.001）。糖尿病、高胆固醇和高血压负担增加主要集中在60岁及以上人群、收入最低的五分之一人群以及高BMI（30 - 34.9和35及以上）人群。糖尿病和CVD负担增加主要集中在每周MET - hr/周为0的人群。从理论上讲，如果成年人未曾接触过BMI在25 - 29.9之间（PAR为9% - 17%）、BMI在30及以上（PAR为1% - 14%）以及每周MET - hr/周为0（PAR为6% - 14%）的情况，许多慢性病病例本可得到预防。要扭转慢性病负担不断上升的趋势，需要在整个生命周期内减少对生活方式危害的接触。CVD和高血压患病率的下降可能得益于有针对性的医疗保健改善，这表明还有更多工作可以而且应该去做。
