On Target Health Data LLC, Suffield, CT, USA.
BRFSS Program, Wyoming Department of Health, Cheyenne, WY, USA.
Prev Med. 2019 Mar;120:113-118. doi: 10.1016/j.ypmed.2019.01.006. Epub 2019 Jan 15.
We studied associations between 7 cardiovascular disease (CVD) risk factors (RFs) and 9 chronic conditions and estimated population-attributable risk. Data (N = 358,218) were from the 2017 Behavioral Risk Factor Surveillance System. Outcomes included asthma, arthritis, chronic obstructive pulmonary disease (COPD), cognitive impairment, CVD, and kidney disease. Risk factors (RF) were obesity, ever smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption, while hypertension, high cholesterol, and diabetes were considered in both categories. Stata was used to study associations in both unadjusted and adjusted analysis. Population-attributable risk was estimated in Excel using adjusted odds ratios (AORs) and compared results using all RFs versus only those where causality was confirmed by other studies. RF prevalence rates ranged from 10.8% (95% CI 10.6, 11.0) for diabetes to 84.1% (83.8, 84.3) for inadequate fruit and vegetable consumption. Almost all adults (95.2%) reported ≥1 RF. Highest total PARs for RFs with confirmed causality were for obesity and ever smoking, and for hypertension when all RFs were considered. Total PARs for the 9 outcomes averaged 37.2-41.5% when results were limited to RFs with confirmed causality. Although the number of risk factors for which causality had been confirmed ranged from 1 to 6, all 9 outcomes showed linear dose response gradients with added risk factors. While all 7 RFs appeared important to address, targeting smoking and obesity with programs that have shown previous success offers the greatest potential for reducing burden for these 9 chronic diseases.
我们研究了 7 种心血管疾病（CVD）风险因素（RFs）和 9 种慢性疾病之间的关联，并估计了人群归因风险。数据（N=358218）来自 2017 年行为风险因素监测系统。结果包括哮喘、关节炎、慢性阻塞性肺疾病（COPD）、认知障碍、CVD 和肾脏疾病。风险因素（RF）包括肥胖、曾经吸烟、久坐的生活方式和水果和蔬菜摄入不足，而高血压、高胆固醇和糖尿病在这两个类别中都被考虑在内。使用 Stata 在未调整和调整分析中研究关联。在 Excel 中使用调整后的优势比（AOR）估计人群归因风险，并使用所有 RF 与仅使用其他研究证实因果关系的 RF 比较结果。RF 流行率范围从糖尿病的 10.8%（95%CI 10.6，11.0）到水果和蔬菜摄入不足的 84.1%（83.8，84.3）。几乎所有成年人（95.2%）报告了≥1 种 RF。具有因果关系的 RF 中总 PAR 最高的是肥胖和曾经吸烟，而当考虑所有 RF 时，总 PAR 最高的是高血压。当结果仅限于因果关系已证实的 RF 时，9 种结果的平均总 PAR 为 37.2-41.5%。尽管已证实因果关系的风险因素数量从 1 个到 6 个不等，但所有 9 种结果都显示出与危险因素增加相关的线性剂量反应梯度。虽然所有 7 种 RF 似乎都很重要，但通过已经证明有成效的项目来解决吸烟和肥胖问题，为这些 9 种慢性疾病减轻负担提供了最大的潜力。
