Crombie I K, Kenicer M B, Smith W C, Tunstall-Pedoe H D
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee.
Br Heart J. 1989 Feb;61(2):172-7. doi: 10.1136/hrt.61.2.172.
Scotland, which has one of the highest death rates in the world from coronary heart disease, also has considerable regional variation in mortality from this cause. The relation between standardised mortality ratios for coronary deaths (1979-83) for 56 local government districts and a range of socioeconomic factors from the 1981 Census as well as climatic factors and water hardness were investigated. Strong associations were seen with several measures of social disadvantage, the strongest being with percentage of male unemployment. A fitted multiple regression model with mortality from coronary heart disease in men found independent effects of two social variables (percentage male unemployment and percentage social class III-V) and one climatic factor (rainfall). The model explained much (73%) of the geographical variation in mortality from coronary heart disease, but part of the geographical pattern, in particular some of the east-west gradient in mortality, remained unexplained by it. Explanations for the geographical variation and the association with economic factors are currently being sought in terms of individual risk factors in a large screening study, the Scottish Heart Health Study.
苏格兰是世界上冠心病死亡率最高的地区之一，且因该病因导致的死亡率在地区间也存在显著差异。研究了56个地方政府辖区的冠心病标准化死亡率（1979 - 1983年）与一系列来自1981年人口普查的社会经济因素、气候因素以及水硬度之间的关系。发现与多种社会劣势指标存在强关联，其中最强的是男性失业率。对男性冠心病死亡率进行拟合的多元回归模型发现，两个社会变量（男性失业率百分比和社会阶层III - V的百分比）和一个气候因素（降雨量）具有独立影响。该模型解释了冠心病死亡率地理差异的大部分（73%），但部分地理模式，特别是死亡率的一些东西向梯度，仍无法用该模型解释。目前正在一项大型筛查研究——苏格兰心脏健康研究中，从个体风险因素的角度寻找地理差异及与经济因素关联的解释。
