二十年来城市化进程中中国青少年心血管风险生物标志物的城乡不平等趋势：1991-2011 年。
Trends in urban/rural inequalities in cardiovascular risk bio-markers among Chinese adolescents in two decades of urbanisation: 1991-2011.
机构信息
Social Statistics, Cathie Marsh Institute, School of Social Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
出版信息
Int J Equity Health. 2018 Jul 11;17(1):101. doi: 10.1186/s12939-018-0813-1.
BACKGROUND
China has seen rapid socio-economic changes and epidemiological transitions in the last few decades. Previous studies often fail to examine how wider macro-level forces contribute to changes in health inequality among its population in China. This study aims to examine urban/rural inequalities in cardiovascular (CVD) risks biomarkers among Chinese adolescents in two decades from 1991 to 2011 during the process of China's rapid urbanisation.
METHODS
Data were drawn from a nationwide longitudinal dataset of the China Health and Nutrition Survey (CHNS) (Sweeps 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011). Children aged between 12 and 18 years (Boys: n = 3472; Girl: n = 3155) were included. A dynamic urbanisation index was created for each community (village or neighbourhood) based on community-level data that can reveal the heterogeneity within and across places and capture dimensions of social, economic and physical characteristics of urban living over time and space. Linear multilevel modeling analyses (Level 1: Occasions; Level-2: Individuals; Level-3: Households; Level-4: Communities) were performed on outcomes of CVD risk biomarkers including anthropometric measures and blood pressure.
RESULTS
After adjustment for age, maternal education and household income per capita, cardiovascular (CVD) risk biomarkers increase among Chinese adolescents during 1991 to 2011. Urbanisation tends to have an independent and positive impact on body mass index (BMI) and waist circumference for boys but not for girls. Positive interaction effect between urbanisation index and survey years for waist circumference was observed for girls (0.005; 95% confidence interval [CI], 0.002, 0.007; p < 0.01): time trends become greater when areas become more urbanized. For blood pressure, when areas become more urbanized the trends for boys become decreased (- 0.005; 95% CI, - 0.009, - 0.002; p < 0.01 for systolic blood pressure and - 0.003; 95% CI, - 0.006, - 0.001; p < 0.05 for diastolic blood pressure).
CONCLUSION
Chinese adolescents are experiencing an upward trend of cardiovascular (CVD) risks in last two decades. Its rapid urbanisation appears to further increase urban/rural inequalities in CVD risks, especially for boys from less urbanised areas and girls from more urbanised areas, which may contribute to the development of cardiovascular disease (CVD) in adulthood. It is relevant to inform policy making process to target specific vulnerable groups. Given China's urbanisation is strongly influenced by the state, there is a possibility for policy intervention to reduce inequality during the process of China's planned urbanisation.
背景
过去几十年，中国经历了快速的社会经济变革和流行病学转变。先前的研究往往未能考察更广泛的宏观力量如何促成中国人口健康不平等状况的变化。本研究旨在探讨 1991 年至 2011 年期间中国快速城市化进程中，城市/农村心血管（CVD）风险生物标志物在青少年中的变化情况。
方法
数据来自全国性的中国健康与营养调查（CHNS）（1991 年、1993 年、1997 年、2000 年、2004 年、2006 年、2009 年和 2011 年）的纵向数据集。纳入年龄在 12 至 18 岁之间的儿童（男生：n=3472；女生：n=3155）。根据社区（村庄或社区）级别的数据，为每个社区创建了一个动态城市化指数，该指数可以揭示社区内部和之间的异质性，并捕捉到城市生活在时间和空间上的社会、经济和物质特征的各个维度。采用线性多层模型分析（水平 1：时间点；水平 2：个体；水平 3：家庭；水平 4：社区）对 CVD 风险生物标志物的结果进行分析，包括人体测量指标和血压。
结果
调整年龄、母亲教育程度和人均家庭收入后，1991 年至 2011 年间，中国青少年的 CVD 风险生物标志物呈上升趋势。城市化往往对男孩的体重指数（BMI）和腰围有独立的积极影响，但对女孩没有影响。对女孩的腰围观察到城市化指数与调查年份之间的正交互作用（0.005；95%置信区间[CI]，0.002，0.007；p<0.01）：当地区变得更加城市化时，趋势变得更大。对于血压，当地区变得更加城市化时，男孩的趋势下降（收缩压为-0.005；95%CI，-0.009，-0.002；p<0.01；舒张压为-0.003；95%CI，-0.006，-0.001；p<0.05）。
结论
在过去的二十年中，中国青少年的心血管（CVD）风险呈上升趋势。其快速城市化似乎进一步加剧了城市/农村 CVD 风险的不平等，尤其是来自欠发达地区的男孩和来自发达地区的女孩，这可能导致成年人心血管疾病（CVD）的发展。这与制定有针对性的弱势群体政策有关。鉴于中国的城市化深受国家影响，因此有可能在城市化进程中通过政策干预来减少不平等。
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