School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile.
Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Glob Heart. 2018 Mar;13(1):19-26. doi: 10.1016/j.gheart.2017.09.001. Epub 2017 Nov 13.
Social determinants differ between countries, which is not always considered when adapting health policies and interventions to face inequalities in noncommunicable diseases and their risk factors.
The study sought to analyze educational inequalities in controlled blood pressure (CBP), obesity, and smoking in study populations from Chile and the United States in 2 periods, both countries with large social inequalities.
The study used data from the first and fifth waves of the MESA (Multiethnic Study of Atherosclerosis) cohort, and the 2003 and 2009 to 2010 Chilean National Health Survey (CNHS) survey outcome measures. The study compared cardiovascular risk factors prevalence as well as relative index of inequality (RII) and slope index of inequality (SII) between the 2 samples.
In the CNHS 67.9% and 52.6% of participants had below primary education in 2003 and 2009 to 2010, respectively, compared with 12.3% and 8.1% in the first and fifth waves of the MESA study, respectively. Smoking prevalence was higher and increased in the CNHS compared with the MESA study, concentrated in better-educated women in both years (RII: 0.34; 95% confidence interval [CI]: 0.17 to 0.68; and RII: 0.55; 95% CI: 0.34 to 0.89, respectively). In contrast, smoking decreased over time in the MESA study in all socioeconomic strata, although relative inequalities increased in both sexes (for women, RII: 2.32; 95% CI 1.36 to 3.97; for men, RII: 3.34; 95% CI 2.04 to 5.47). CBP prevalence in both periods was higher in the first and fifth waves of the MESA study (69.7% and 80.2%) compared with the 2003 and 2009 to 2010 CNHS samples (34.2% and 52.3%), but only for the MESA study RII, favoring the better educated, was it significant in both periods and sexes. Obesity inequalities for Chilean women decreased slightly between 2003 and 2009 as prevalence grew in the most educated (RII: 2.21 to 1.68; SII: 0.29 to 0.22, respectively); conversely, they increased for both sexes in the MESA study.
The study findings confirm that patterns and trends in prevalence, and absolute and relative inequalities vary by country, suggesting that context and cultural issues matters.
社会决定因素因国家而异，在调整卫生政策和干预措施以应对非传染性疾病及其危险因素方面的不平等时，这些因素往往没有得到考虑。
本研究旨在分析智利和美国两个社会不平等程度较大的国家在两个时期的 MESA（多民族动脉粥样硬化研究）队列的第一和第五波以及 2003 年和 2009 年至 2010 年智利国家健康调查（CNHS）调查结果中，受教育程度不同的人群在控制血压（CBP）、肥胖和吸烟方面的差异。
本研究使用了 MESA 队列的第一和第五波以及 2003 年和 2009 年至 2010 年智利国家健康调查（CNHS）调查结果的数据。研究比较了两个样本中心血管风险因素的患病率以及相对不平等指数（RII）和不平等斜率指数（SII）。
在 CNHS 中，2003 年和 2009 年至 2010 年分别有 67.9%和 52.6%的参与者受教育程度低于小学，而在 MESA 研究的第一和第五波中，这一比例分别为 12.3%和 8.1%。与 MESA 研究相比，CNHS 中的吸烟率更高且呈上升趋势，主要集中在受教育程度较高的女性中（RII：0.34；95%置信区间[CI]：0.17 至 0.68；RII：0.55；95%CI：0.34 至 0.89）。相反，尽管在所有社会经济阶层中，MESA 研究中的吸烟率都随时间下降，但两性的相对不平等程度都有所增加（对于女性，RII：2.32；95%CI 1.36 至 3.97；对于男性，RII：3.34；95%CI 2.04 至 5.47）。在这两个时期，MESA 研究的第一和第五波中 CBP 的患病率（分别为 69.7%和 80.2%）均高于 2003 年和 2009 年至 2010 年 CNHS 样本（分别为 34.2%和 52.3%），但只有 MESA 研究在两个时期和两个性别中，RII 有利于受教育程度较高的人群，这才有统计学意义。智利女性的肥胖不平等现象在 2003 年至 2009 年间略有下降，因为受教育程度较高的人群中肥胖率有所上升（RII：2.21 至 1.68；SII：0.29 至 0.22）；相反，在 MESA 研究中，两性的肥胖不平等现象都有所增加。
研究结果证实，患病率、绝对和相对不平等的模式和趋势因国家而异，这表明背景和文化问题很重要。
