一项比较新西兰农村毛利人、城市毛利人和非毛利人社区心血管危险因素的队列研究。
A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand.
作者信息
Cameron Vicky A, Faatoese Allamanda F, Gillies Matea W, Robertson Paul J, Huria Tania M, Doughty Rob N, Whalley Gillian A, Richards Mark A, Troughton Richard W, Tikao-Mason Karen N, Wells Elisabeth J, Sheerin Ian G, Pitama Suzanne G
机构信息
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
出版信息
BMJ Open. 2012 Jun 8;2(3). doi: 10.1136/bmjopen-2011-000799. Print 2012.
OBJECTIVES
To understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services.
DESIGN
Prospective cohort study.
SETTING
Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand.
PARTICIPANTS
Screening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20-64 years.
MAIN OUTCOME MEASURES
The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities.
RESULTS
Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m(2), p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts.
CONCLUSIONS
Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.
目的
为了解新西兰原住民毛利人在心血管疾病（CVD）方面的健康差异，对远离医疗服务机构地区的农村毛利人与医疗服务完善城市中的城市毛利人和非毛利人已诊断和未诊断的CVD风险因素进行比较。
设计
前瞻性队列研究。
背景
“奥拉马纳瓦”（Hauora Manawa）是一项关于已诊断和先前未诊断的CVD、糖尿病及风险因素的队列研究，基于从新西兰怀罗阿地区农村和克赖斯特彻奇市的选民名册中随机选取。
参与者
252名年龄在20 - 64岁的农村毛利人、243名城市毛利人和256名城市非毛利人参加了筛查诊所。
主要观察指标
该研究记录了个人和家族病史、血压、人体测量学指标、空腹血脂、胰岛素、血糖、糖化血红蛋白（HbA1c）和尿酸，以确定三个社区共有的风险因素以及不同的风险因素。
结果
农村毛利人、城市毛利人和非毛利人的平均年龄（标准差）分别为45.7（11.5）岁、42.6（11.2）岁和43.6（11.5）岁。各队列中经年龄调整的已诊断心脏病发病率无显著差异（7.5%对5.8%对2.8%，p = 0.073）。然而，农村毛利人的2型糖尿病发病率显著更高（10.7%对3.7%对2.4%，p < 0.001）、已诊断高血压发病率（25.0%对14.9%对10.7%，p < 0.001）、接受治疗的血脂异常发病率（15.7%对7.1%对2.8%，p < 0.001）、当前吸烟率（42.8%对30.5%对15.2%，p < 0.001）以及经年龄调整的体重指数（30.7（7.3）对29.1（6.4）对26.1（4.5）kg/m²，p < 0.001）。在所有队列中还观察到先前未记录的高血压（22.2%对23.5%对17.6%，p = 0.23）和高胆固醇（42.1%对54.3%对42.2%，p = 0.008）发病率同样较高。
结论
支持综合性农村医疗保健以提供CVD风险因素的筛查和管理，将减少这一原住民群体中的健康差异。
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