Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Sci Rep. 2020 Nov 27;10(1):20796. doi: 10.1038/s41598-020-77877-3.
Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40-69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1-40.1) among men and 22.1% (10.4-31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9-10 to 7-8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.
令人惊讶的是，很少有人试图量化已确立的风险因素对国家间 CVD 死亡率差异的综合贡献。我们旨在开发并批判性地评估一种这样做的方法，并将其应用于俄罗斯和挪威之间存在的大量 CVD 死亡率差距，使用了三个城市的调查数据和新兴风险因素协作组的死亡率风险。我们估计了归因于风险因素的国家间 40-69 岁人群 CVD 死亡率的绝对和相对差异，假设俄罗斯的年龄和性别特定风险因素状况与挪威相同，反之亦然。在俄罗斯具有挪威风险因素特征的假设下，男性的年龄标准化 CVD 死亡率差距将减少 33.3%（95%CI 25.1-40.1），女性减少 22.1%（10.4-31.3）。相对而言，死亡率比（俄罗斯/挪威）将从 9-10 下降到 7-8。在挪威具有俄罗斯风险因素特征的假设下，死亡率差距减少较少。已确立的 CVD 风险因素占俄罗斯和挪威之间男性 CVD 死亡率差距的三分之一，约占女性 CVD 死亡率差距的四分之一。然而，这些估计是基于广泛持有的流行病学假设，值得进一步审查。
