MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Int J Epidemiol. 2013 Jun;42(3):838-48. doi: 10.1093/ije/dyt063. Epub 2013 Jun 5.
Cardiovascular disease mortality has declined and diabetes mortality has increased in high-income countries. We estimated the potential role of trends in population body mass index, systolic blood pressure, serum total cholesterol and smoking in cardiometabolic mortality decline in 26 industrialized countries.
Mortality data were from national vital statistics. Body mass index, systolic blood pressure and serum total cholesterol were from a systematic analysis of population-based data. We estimated the associations between change in cardiometabolic mortality and changes in risk factors, adjusted for change in per-capita gross domestic product. We calculated the potential contribution of risk factor trends to mortality decline.
Between 1980 and 2009, age-standardized cardiometabolic mortality declined in all 26 countries, with the annual decline between <1% in Mexico to ≈ 5% in Australia. Across the 26 countries together, risk factor trends may have accounted for ≈ 48% (men) and ≈ 40% (women) of cardiometabolic mortality decline. Risk factor trends may have accounted for >60% of decline among men and women in Finland and Switzerland, men in New Zealand and France, and women in Italy; their benefits were smallest in Mexican, Portuguese, and Japanese men and Mexican women. Risk factor trends may have slowed down mortality decline in Chilean men and women and had virtually no effect in Argentinean women. The contributions of risk factors to mortality decline seemed substantially larger among men than among women in the USA, Canada and The Netherlands.
Industrialized countries have varied widely in the extent of risk factor prevention, and its likely benefits for cardiometabolic mortality.
在高收入国家，心血管疾病死亡率有所下降，而糖尿病死亡率有所上升。我们评估了 26 个工业化国家人口体重指数、收缩压、血清总胆固醇和吸烟趋势在心血管代谢死亡率下降中的潜在作用。
死亡率数据来自国家生命统计数据。体重指数、收缩压和血清总胆固醇来自对基于人群的数据进行的系统分析。我们评估了心血管代谢死亡率变化与危险因素变化之间的关联，并根据人均国内生产总值的变化进行了调整。我们计算了危险因素趋势对死亡率下降的潜在贡献。
1980 年至 2009 年间，26 个国家的标准化心血管代谢死亡率均有所下降，墨西哥的年降幅<1%，澳大利亚的年降幅约为 5%。在这 26 个国家中，危险因素趋势可能导致心血管代谢死亡率下降了约 48%（男性）和 40%（女性）。在芬兰和瑞士、新西兰和法国的男性以及意大利的女性中，危险因素趋势可能导致心血管代谢死亡率下降超过 60%；在墨西哥、葡萄牙和日本的男性和墨西哥的女性中，其益处最小。在智利的男性和女性以及阿根廷的女性中，危险因素趋势可能减缓了死亡率的下降，在阿根廷的女性中几乎没有影响。在美国、加拿大和荷兰，危险因素对死亡率下降的贡献似乎在男性中明显大于女性。
工业化国家在危险因素预防的程度及其对心血管代谢死亡率的可能益处方面存在很大差异。
