Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Public Health and Community Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Am J Hypertens. 2020 Aug 4;33(8):718-725. doi: 10.1093/ajh/hpaa075.
There is no general agreement on underlying pathophysiology explaining the high burden of cardiovascular disease on people at low socioeconomic status (SES). This study was conducted to investigate the association between healthcare systems and arterial stiffness.
A total of 8,929 subjects (60 years old and 55% were male) who underwent brachial-ankle pulse wave velocity (baPWV) measurement were retrospectively analyzed. There were 8,237 National Health Insurance (NHI) beneficiaries (92.2%) and 692 medical aid (MA) beneficiaries (7.8%). The median value of baPWV was 1,540 cm/s.
Subjects with higher baPWV values (≥1,540 cm/s) were older, and more frequently had cardiovascular risk factors and unfavorable laboratory findings than those with lower values baPWV (<1,540 cm/s). The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries (1,966 ± 495 vs. 1,582 ± 346 cm/s, P < 0.001). The proportion of MA beneficiaries was significantly higher in subjects with higher baPWV than those with lower baPWV (13.1% vs. 2.3%, P < 0.001). In multivariable analysis, MA beneficiaries were significantly associated with higher baPWV values even after controlling for potential confounders (odds ratio, 5.41; 95% confidence intervals, 4.02-7.27; P < 0.001).
The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries. The result of this study provides additional evidence on the association between low SES and arterial stiffening.
目前对于低社会经济地位人群心血管疾病负担较重的潜在病理生理学机制尚未达成共识。本研究旨在探讨医疗体系与动脉僵硬度之间的关系。
回顾性分析了 8929 名接受肱踝脉搏波速度（baPWV）测量的受试者。其中有 8237 名全民健康保险（NHI）受益人和 692 名医疗救助（MA）受益人（分别占 92.2%和 7.8%）。baPWV 的中位数为 1540cm/s。
baPWV 值较高（≥1540cm/s）的受试者年龄较大，且更常伴有心血管危险因素和不利的实验室检查结果，而 baPWV 值较低（<1540cm/s）的受试者则较少。MA 受益人的 baPWV 值明显高于 NHI 受益人的 baPWV 值（1966±495 vs. 1582±346cm/s，P<0.001）。baPWV 值较高的受试者中 MA 受益人的比例明显高于 baPWV 值较低的受试者（13.1% vs. 2.3%，P<0.001）。多变量分析显示，在校正了潜在混杂因素后，MA 受益人与较高的 baPWV 值显著相关（优势比，5.41；95%置信区间，4.02-7.27；P<0.001）。
MA 受益人的 baPWV 值明显高于 NHI 受益人的 baPWV 值。本研究结果为低社会经济地位与动脉僵硬度之间的关系提供了额外的证据。
