Alvarado Beatriz E, Harper Sam, Platt Robert W, Smith George Davey, Lynch John
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):598-606. doi: 10.1161/CIRCOUTCOMES.109.884601. Epub 2009 Aug 25.
The US Healthy People 2010 (HP2010) agenda set targets for major risk factors for coronary heart disease (CHD). However, the potential impact of achieving those risk factor reductions on both population levels and social disparities in CHD has not been quantified.
Data on 10-year risk of CHD (from the First National Health and Nutrition Examination Epidemiological Follow-Up study 1971 to 1982), prevalence of major CHD risk factors (from the National Health and Nutrition Examination Survey 2003 to 2004), and HP2010 targets for CHD risk factors (reduction of smoking rate to 12%, hypertension to 14%, high cholesterol levels to 17%, diabetes to 2.5%, and obesity to 15%) were used to estimate effects of different scenarios on population levels and social disparities in CHD. Over a 10-year period, the largest relative reductions in population levels of CHD (20.0% in men; 23.9% in women) would be achieved if all social groups met the HP2010 targets. CHD disparities would be most reduced if the less educated (absolute disparities reduced by 66.1% in men; 56.3% in women) and the low income group (absolute disparities reduced by 93.7% in men; 94.3% in women) achieved the targets before the most advantaged. These reductions are larger than those expected if targets were achieved overall for the population but relative social group differences in risk factors remained, or under leveling-up approaches in which the least advantaged achieved the current levels of risk factors of the most advantaged.
Interventions to reduce CHD risk factors to HP2010 targets that focus on all social groups would produce the best overall scenario for both population levels and disparities in CHD.
美国《健康人民2010》（HP2010）议程设定了冠心病（CHD）主要危险因素的目标。然而，实现这些危险因素降低对冠心病的人群水平和社会差异的潜在影响尚未得到量化。
利用冠心病10年风险数据（来自1971年至1982年的首次全国健康与营养检查流行病学随访研究）、主要冠心病危险因素患病率（来自2003年至2004年的全国健康与营养检查调查）以及HP2010冠心病危险因素目标（将吸烟率降至12%，高血压降至14%，高胆固醇水平降至17%，糖尿病降至2.5%，肥胖降至15%）来估计不同情景对冠心病人群水平和社会差异的影响。在10年期间，如果所有社会群体都达到HP2010目标，冠心病人群水平的最大相对降低幅度将实现（男性为20.0%；女性为23.9%）。如果受教育程度较低的群体（男性绝对差异降低66.1%；女性降低56.3%）和低收入群体（男性绝对差异降低93.7%；女性降低94.3%）比最具优势群体先实现目标，冠心病差异将得到最大程度的减少。这些降低幅度大于总体人群实现目标但危险因素的相对社会群体差异仍然存在时的预期，也大于在提升策略下最弱势群体达到最具优势群体当前危险因素水平时的预期。
将冠心病危险因素降低至HP2010目标的干预措施，若关注所有社会群体，将为冠心病的人群水平和差异产生最佳的总体情景。
