Otten M W, Teutsch S M, Williamson D F, Marks J S
Epidemiology Program Office, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1990 Feb 9;263(6):845-50.
We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.
在第一次全国健康与营养检查调查的流行病学随访研究中，我们比较了黑人和白人成年人在调整不同风险因素前后的死亡率比值。对于35至54岁的人群，在同时调整六个已确定的风险因素（吸烟、收缩压、胆固醇水平、体重指数、酒精摄入量和糖尿病）时，黑人与白人的死亡率比值从2.3（未调整）降至1.9；在调整六个风险因素加上家庭收入后，该比值从1.9降至1.4。因此，约31%的额外死亡率可归因于六个已确定的风险因素，另有38%可归因于家庭收入。这就留下了31%无法解释的部分。若要实现健康方面的平等目标，可能需要更广泛的社会和卫生系统变革、针对死亡率差距成因的研究，以及加大针对可改变风险因素的努力。
