在常规初级保健中对居住在新西兰的太平洋岛民和欧洲人的心血管疾病风险因素概况进行的比较分析：PREDICT CVD - 11。

A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11.

作者信息

Grey Corina, Wells Sue, Riddell Tania, Kerr Andrew, Gentles Dudley, Pylypchuk Romana, Marshall Roger, Ameratunga Shanthi, Drury Paul, Elley C Raina, Kyle Cambell, Exeter Daniel, Jackson Rod

机构信息

Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, PO Box 92019, Auckland, New Zealand.

出版信息

N Z Med J. 2010 Feb 19;123(1309):62-75.

DOI:

PMID:20186243

Abstract

AIM

To investigate the differences in the baseline cardiovascular disease (CVD) risk profiles of Pacific peoples and Europeans assessed in routine primary care practice by PREDICT, a web-based clinical decision support programme for assessing and managing CVD risk.

METHODS

PREDICT has been implemented in primary care practices from nine consenting PHOs in Auckland and Northland. Between 2002 and January 2009, over 70,000 CVD risk assessments were conducted. These analyses compare CVD risk factors for Pacific and European patients.

RESULTS

Baseline risk assessments were completed for 39,835 Europeans and 10,301 Pacific peoples aged 35-74 years. Over 85% of the Pacific cohort was comprised of the four main Pacific ethnic groups in New Zealand (Samoan, Tongan, Cook Island Maori and Niuean). Fijians (n=1341) were excluded from the analyses because of a likely misclassification error with Indian Fijians. On average, Pacific peoples in the PREDICT cohort were 4 years younger at the time of risk assessment than Europeans, and were overrepresented in areas of high socioeconomic deprivation. At risk assessment, Pacific men were 1.5 times as likely to be current smokers as European men, whereas similar or lower proportions of Pacific women smoked compared with European women. Pacific peoples were approximately three times more likely to have diabetes as Europeans. Pacific peoples had higher diastolic blood pressures and Pacific women had higher total cholesterol/HDL ratios. Both Pacific men and women had a significantly higher predicted risk of CVD in the next 5 years than Europeans, based on the Framingham risk score.

CONCLUSIONS

The PREDICT programme has already generated the largest cohort of Pacific peoples ever to be studied in New Zealand. This comparative analysis of patients who have been screened highlights significant disparities in CVD risk factors for Pacific peoples particularly for diabetes in both sexes and for smoking in men. Targeting these modifiable risk factors will be important in addressing the widening inequalities in CVD outcomes between Pacific peoples and Europeans.

摘要

目的

通过PREDICT（一个用于评估和管理心血管疾病风险的基于网络的临床决策支持项目），调查在常规初级保健实践中评估的太平洋岛民和欧洲人的基线心血管疾病（CVD）风险概况的差异。

方法

PREDICT已在奥克兰和北地的9个同意参与的初级卫生组织的初级保健实践中实施。在2002年至2009年1月期间，进行了超过70000次心血管疾病风险评估。这些分析比较了太平洋岛民和欧洲患者的心血管疾病风险因素。

结果

对39835名35 - 74岁的欧洲人和10301名太平洋岛民完成了基线风险评估。超过85%的太平洋岛民队列由新西兰四个主要的太平洋族裔群体（萨摩亚人、汤加人、库克群岛毛利人和纽埃人）组成。由于与印度斐济人可能存在分类错误，斐济人（n = 1341）被排除在分析之外。在PREDICT队列中，太平洋岛民在进行风险评估时平均比欧洲人年轻4岁，并且在社会经济高度贫困地区的比例过高。在风险评估时，太平洋岛民男性当前吸烟的可能性是欧洲男性的1.5倍，而与欧洲女性相比，太平洋岛民女性吸烟的比例相似或更低。太平洋岛民患糖尿病的可能性大约是欧洲人的三倍。太平洋岛民的舒张压更高，太平洋岛民女性的总胆固醇/高密度脂蛋白比率更高。根据弗雷明汉风险评分，在未来5年中，太平洋岛民男性和女性发生心血管疾病的预测风险均显著高于欧洲人。

结论

PREDICT项目已经产生了新西兰有史以来研究的最大规模的太平洋岛民队列。对接受筛查的患者进行的这项比较分析突出了太平洋岛民在心血管疾病风险因素方面的显著差异，特别是在两性糖尿病和男性吸烟方面。针对这些可改变的风险因素对于解决太平洋岛民和欧洲人在心血管疾病结果方面日益扩大的不平等问题将具有重要意义。