重新审视中国城市居民中风患病率的社会经济不平等现象：拐点是否临近？

Re-look at socioeconomic inequalities in stroke prevalence among urban Chinese: is the inflexion approaching?

机构信息

Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.

Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.

出版信息

BMC Public Health. 2018 Mar 20;18(1):367. doi: 10.1186/s12889-018-5279-y.

DOI:10.1186/s12889-018-5279-y

PMID:29554881

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5859657/

Abstract

BACKGROUND

The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. We hypothesized that the SES-stroke relationship in developing societies mirrors the trajectory of the Western countries at some stage of economic development. This study aimed to examine whether this inflexion is approaching in China.

METHODS

This study comprises of two cross-sectional surveys conducted in the same urban areas of Nanjing, China in 2000 (S2000) and 2011 (S2011) using the same selection criteria (i.e., aged≥35 years) and sampling approach. Physician-diagnosed stroke was the outcome event, while family average income (FAI) was the explanatory variable and tertiled in our anlaysis. Mixed-effects models were used to examine the FAI-stroke association.

RESULTS

Overall, 19,861 (response rate = 90.1%) and 7824 (response rate = 82.8%) participants participated in the S2000 and S2011, respectively. The prevalence of stroke increased by 2.5-folds (95%CI = 2.2, 2.9) from 2000 (2.1%, 95%CI = 1.9%, 2.3%) to 2011 (5.1%, 95%CI = 4.6%, 5.6%) (p < 0.01). Compared with the lower FAI category, the positive association between stroke prevalence and the higher FAI group decreased from 1.99 (95%CI = 1.55, 2.56) in 2000 to 1.49 (95%CI = 1.09, 2.03) in 2011 after control for potential confounders. A similar pattern was also observed for the middle FAI group (1.60, 95% CI = 1.23, 2.08 in 2000 vs. 1.37, 95%CI = 1.01, 1.88 in 2011).

CONCLUSIONS

This study revealed that socioeconomic inequalities in stroke were diminishing in regional China during the recent 11-year period, although the SES-stroke association was still positive. Tailored intervention against stroke should currently target on SES-vulnerable people.

摘要

背景

在发展中社区，社会经济地位（SES）与中风之间呈正相关，但在几十年前就记录到 SES 与中风呈正相关的发达国家，这种关系却是负相关。我们假设，发展中社会的 SES-中风关系在经济发展的某个阶段反映了西方国家的轨迹。本研究旨在探讨这种转变是否正在中国发生。

方法

本研究包括在中国南京市同一城区进行的两项横断面调查，分别在 2000 年（S2000）和 2011 年（S2011）进行，采用相同的选择标准（即年龄≥35 岁）和抽样方法。医生诊断的中风是结果事件，而家庭平均收入（FAI）是解释变量，并在我们的分析中进行了分层。使用混合效应模型来检验 FAI-中风的关联。

结果

总体而言，分别有 19861 名（应答率=90.1%）和 7824 名（应答率=82.8%）参与者参加了 S2000 和 S2011。从 2000 年（2.1%，95%CI=1.9%，2.3%）到 2011 年（5.1%，95%CI=4.6%，5.6%），中风的患病率增加了 2.5 倍（95%CI=2.2，2.9）（p<0.01）。与较低的 FAI 类别相比，中风患病率与较高 FAI 组之间的正相关关系从 2000 年的 1.99（95%CI=1.55，2.56）下降到 2011 年的 1.49（95%CI=1.09，2.03），在控制了潜在的混杂因素后。在中等 FAI 组中也观察到了类似的模式（2000 年为 1.60，95%CI=1.23，2.08，2011 年为 1.37，95%CI=1.01，1.88）。