Division of Medicine, University College London, London, UK.
BMC Cardiovasc Disord. 2010 Oct 8;10:50. doi: 10.1186/1471-2261-10-50.
Rural-to-urban migration in low- and middle-income countries causes an increase in individual cardiovascular risk. Cost-effective interventions at early stages of the natural history of coronary disease such as angina may stem an epidemic of premature coronary deaths in these countries. However, there are few data on the prevalence of angina in developing countries, whilst the understanding the aetiology of angina is complicated by the difficulty in measuring it across differing populations.
The PERU MIGRANT study was designed to investigate differences between rural-to-urban migrant and non-migrant groups in specific cardiovascular disease risk factors. Mass-migration seen in Peru from 1980s onwards was largely driven by politically motivated violence resulting in less 'healthy migrant' selection bias. The Rose angina questionnaire was used to record chest pain, which was classified definite, possible and non-exertional. Mental health was measured using the General Health Questionnaire (GHQ-12). Mantel-Haenszel odds ratios (adjusted for age, sex, cardiovascular disease risk factors and mental health) were used to assess the risk of chest pain in the migrant and urban groups compared to the rural group, and further to assess the relationship (age and sex-adjusted) between risk factors, mental health and chest pain.
Compared to the urban group, rural dwellers had a greatly increased likelihood of possible/definite angina (multi-adjusted OR 2.82 (1.68- 4.73)). Urban and migrant groups had higher levels of risk factors (e.g. smoking--20.1% urban, 5.5% rural). No diabetes was seen in the rural dwellers who complained of possible/definite angina. Rural dwellers had a higher prevalence of mood disorder and the presence of a mood disorder was associated with possible/definite angina in all three groups, but not consistently with non-exertional chest pain.
Rural groups had a higher prevalence of angina as measured by Rose questionnaire than migrants and urban dwellers, and a higher prevalence of mood disorder. The presence of a mood disorder was associated with angina. The Rose angina questionnaire may not be of relevance to rural populations in developing countries with a low pre-test probability of coronary disease and poor mental health.
在中低收入国家，农村向城市的移民导致个体心血管风险增加。在冠心病自然史的早期阶段，如心绞痛，采取具有成本效益的干预措施可能会阻止这些国家过早出现冠心病死亡的流行。然而，发展中国家心绞痛的患病率数据很少，而由于在不同人群中测量心绞痛的难度，对心绞痛病因的理解变得复杂。
PERU MIGRANT 研究旨在调查农村到城市移民和非移民群体在特定心血管疾病危险因素方面的差异。20 世纪 80 年代以来，秘鲁出现了大规模移民，这主要是由政治动机引发的暴力事件造成的，导致“健康移民”的选择偏差较小。使用 Rose 心绞痛问卷记录胸痛，将胸痛分为明确、可能和非劳累性。使用一般健康问卷（GHQ-12）测量心理健康。使用 Mantel-Haenszel 比值比（调整年龄、性别、心血管疾病危险因素和心理健康因素）来评估移民和城市组与农村组相比胸痛的风险，并进一步评估危险因素、心理健康与胸痛之间的关系（年龄和性别调整）。
与城市组相比，农村居民发生可能/明确心绞痛的可能性大大增加（多因素调整比值比 2.82（1.68-4.73））。城市和移民组具有更高水平的危险因素（例如，吸烟率-城市组为 20.1%，农村组为 5.5%）。在抱怨可能/明确心绞痛的农村居民中，未发现糖尿病。农村居民心境障碍的患病率较高，在所有三组中，心境障碍的存在与可能/明确心绞痛有关，但与非劳累性胸痛无关。
农村组使用 Rose 问卷测量的心绞痛患病率高于移民和城市居民，心境障碍的患病率也较高。心境障碍的存在与心绞痛有关。Rose 心绞痛问卷可能不适用于冠心病和心理健康较差的低预测试概率的发展中国家的农村人群。
