Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada2Centre for Statistics in Medicine, University of Oxford, Oxford, England.
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
JAMA Cardiol. 2017 Jul 1;2(7):782-790. doi: 10.1001/jamacardio.2017.1658.
Large improvements in the control of risk factors for cardiovascular disease have been achieved in the United States, but it remains unclear whether adults in all socioeconomic strata have benefited equally.
To assess temporal trends in 10-year predicted absolute cardiovascular risk and cardiovascular risk factors among US adults in different socioeconomic strata.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis was conducted using data on adults 40 to 79 years of age without established cardiovascular disease from the 1999 to 2014 National Health and Nutrition Examination Survey.
Socioeconomic status was based on the family income to poverty ratio and participants were divided into the following 3 groups: high income (family income to poverty ratio, ≥4), middle income (>1 and <4), or at or below the federal poverty level (≤1).
We assessed predicted absolute cardiovascular risk using the pooled cohort equation. We assessed the following 4 risk factors: systolic blood pressure, smoking status, diabetes, and total cholesterol.
Of the 17 199 adults whose data were included in the study (8828 women and 8371 men; mean age, 54.4 years), from 1999-2014, trends in the percentage of adults with predicted absolute cardiovascular risk of 20% or more, mean systolic blood pressure, and the percentage of current smokers varied by income strata (P ≤ .02 for interaction). For adults with incomes at or below the federal poverty level, there was little evidence of a change in any of these outcomes across survey years (cardiovascular risk ≥20%, 14.9% [95% CI, 12.9%-16.8%] in 1999-2004; 16.5% [95% CI, 13.7%-19.2%] in 2011-2014; P = .41; mean systolic blood pressure, 127.6 [95% CI, 126.1-129.0] mm Hg in 1999-2004; 126.8 [95% CI, 125.2-128.5] mm Hg in 2011-2014; P = .44; and smoking, 36.5% [95% CI, 32.1%-41.0%] in 1999-2004; 36.0% [95% CI, 31.1%-40.8%] in 2011-2014; P = .87). For adults in the high-income stratum, these variables decreased across survey years (cardiovascular risk ≥20%, 12.0% [95% CI, 10.7%-13.3%] in 1999-2004; 9.5% [95% CI, 8.2%-10.7%] in 2011-2014; P = .003; systolic blood pressure, 126.0 [95% CI, 125.0-126.9] mm Hg in 1999-2004; 122.3 [95% CI, 121.3-123.3] mm Hg in 2011-2014; P < .001; and smoking, 14.1% [95% CI, 12.0%-16.2%] in 1999-2004; 8.8% [95% CI, 6.6%-11.0%] in 2011-2014; P = .001). Trends in the percentage of adults with diabetes and the mean total cholesterol level did not vary by income.
Adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors.
美国在控制心血管疾病风险因素方面取得了重大进展，但尚不清楚所有社会经济阶层的成年人是否同样受益。
评估美国不同社会经济阶层成年人的 10 年预测绝对心血管风险和心血管风险因素的时间趋势。
设计、设置和参与者：使用 1999 年至 2014 年全国健康与营养调查中没有心血管疾病的 40 至 79 岁成年人的数据进行了一项横断面分析。
社会经济地位基于家庭收入与贫困比例，参与者分为以下 3 组：高收入（家庭收入与贫困比例，≥4）、中收入（>1 且<4）或处于或低于联邦贫困线（≤1）。
我们使用汇总队列方程评估预测的绝对心血管风险。我们评估了以下 4 个风险因素：收缩压、吸烟状况、糖尿病和总胆固醇。
在纳入研究的 17199 名成年人中（女性 8828 人，男性 8371 人；平均年龄 54.4 岁），从 1999 年至 2014 年，具有 20%或更高预测绝对心血管风险、平均收缩压和当前吸烟者百分比的成年人比例因收入阶层而异（交互作用 P≤.02）。对于收入处于或低于联邦贫困线的成年人，这些结果在整个调查年份中几乎没有变化的证据（心血管风险≥20%，1999-2004 年为 14.9%[95%置信区间，12.9%-16.8%]；2011-2014 年为 16.5%[95%置信区间，13.7%-19.2%]；P=.41；平均收缩压，1999-2004 年为 127.6[95%置信区间，126.1-129.0]mmHg；2011-2014 年为 126.8[95%置信区间，125.2-128.5]mmHg；P=.44；吸烟，1999-2004 年为 36.5%[95%置信区间，32.1%-41.0%]；2011-2014 年为 36.0%[95%置信区间，31.1%-40.8%]；P=.87）。对于高收入阶层的成年人，这些变量在调查年份中呈下降趋势（心血管风险≥20%，1999-2004 年为 12.0%[95%置信区间，10.7%-13.3%]；2011-2014 年为 9.5%[95%置信区间，8.2%-10.7%]；P=.003；收缩压，1999-2004 年为 126.0[95%置信区间，125.0-126.9]mmHg；2011-2014 年为 122.3[95%置信区间，121.3-123.3]mmHg；P<.001；吸烟，1999-2004 年为 14.1%[95%置信区间，12.0%-16.2%]；2011-2014 年为 8.8%[95%置信区间，6.6%-11.0%]；P=.001）。成年人患糖尿病和平均总胆固醇水平的百分比趋势不受收入的影响。
每个社会经济阶层的成年人都没有从控制心血管风险因素的努力中同等受益。
