Division of Cardiology, Department of Medicine, Makerere University, Kampala, Uganda.
PLoS One. 2012;7(8):e43917. doi: 10.1371/journal.pone.0043917. Epub 2012 Aug 27.
Although low socioeconomic status, and environmental factors are known risk factors for rheumatic heart disease in other societies, risk factors for rheumatic heart disease remain less well described in Uganda.
The objective of this study was to investigate the role of socio-economic and environmental factors in the pathogenesis of rheumatic heart disease in Ugandan patients.
This was a case control study in which rheumatic heart disease cases and normal controls aged 5-60 years were recruited and investigated for socioeconomic and environmental risk factors such as income status, employment status, distance from the nearest health centre, number of people per house and space area per person.
486 participants (243 cases and 243 controls) took part in the study. Average age was 32.37+/-14.6 years for cases and 35.75+/-12.6 years for controls. At univariate level, Cases tended to be more overcrowded than controls; 8.0+/-3.0 versus 6.0+/-3.0 persons per house. Controls were better spaced at 25.2 square feet versus 16.9 for cases. More controls than cases were employed; 45.3% versus 21.1%. Controls lived closer to health centers than the cases; 4.8+/-3.8 versus 3.3+/-12.9 kilometers. At multivariate level, the odds of rheumatic heart disease was 1.7 times higher for unemployment status (OR = 1.7, 95% CI = 1.05-8.19) and 1.3 times higher for overcrowding (OR = 1.35, 95% CI = 1.1-1.56). There was interaction between overcrowding and longer distance from the nearest health centre (OR = 1.20, 95% CI = 1.05-1.42).
The major findings of this study were that there was a trend towards increased risk of rheumatic heart disease in association with overcrowding and unemployment. There was interaction between overcrowding and distance from the nearest health center, suggesting that the effect of overcrowding on the risk of acquiring rheumatic heart disease increases with every kilometer increase from the nearest health center.
尽管在其他社会中，低社会经济地位和环境因素是风湿性心脏病的已知危险因素，但在乌干达，风湿性心脏病的危险因素仍描述得不够充分。
本研究旨在探讨社会经济和环境因素在乌干达患者风湿性心脏病发病机制中的作用。
这是一项病例对照研究，其中招募了年龄在 5-60 岁的风湿性心脏病病例和正常对照，并调查了社会经济和环境危险因素，如收入状况、就业状况、离最近的卫生中心的距离、每栋房屋的人数和人均空间面积。
486 名参与者（243 例病例和 243 例对照）参加了这项研究。病例的平均年龄为 32.37+/-14.6 岁，对照的平均年龄为 35.75+/-12.6 岁。在单变量水平上，病例比对照更拥挤；每栋房屋 8.0+/-3.0 人对 6.0+/-3.0 人。对照者的人均空间面积较大，为 25.2 平方英尺，而病例为 16.9 平方英尺。与病例相比，更多的对照者有工作；45.3%对 21.1%。对照者比病例更靠近卫生中心；4.8+/-3.8 公里对 3.3+/-12.9 公里。在多变量水平上，失业状态使风湿性心脏病的发病风险增加 1.7 倍（OR = 1.7，95%CI = 1.05-8.19），过度拥挤使风湿性心脏病的发病风险增加 1.3 倍（OR = 1.35，95%CI = 1.1-1.56）。过度拥挤和离最近卫生中心的距离之间存在交互作用（OR = 1.20，95%CI = 1.05-1.42）。
本研究的主要发现是，过度拥挤和失业与风湿性心脏病的风险增加呈趋势相关。过度拥挤和离最近卫生中心的距离之间存在交互作用，这表明，离最近卫生中心的距离每增加一公里，过度拥挤对风湿性心脏病发病风险的影响就会增加。
