Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York University, Toronto, Ontario, Canada.
Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA.
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-006809.
The objective of this study is to examine the temporal trends and patterns of regional and socioeconomic disparities in cardiovascular disease (CVD) in Canada during 2005-2016.
A total of 670 000 adults aged ≥20 years who participated in the Canadian Community Health Surveys between 2005 and 2016 were enrolled for this study. CVD referred to heart disease and stroke in this study. Equivalised household income was used as a proxy of socioeconomic status. Absolute and relative socioeconomic inequalities were measured by slope index of inequality (SII) and relative index of inequality (RII), respectively.
In 2015/2016, the overall age-adjusted and sex-adjusted prevalence of heart disease and stroke was 4.80% (95% CI 4.61% to 4.98%) and 1.25% (95% CI 1.13% to 1.36%), respectively. Trend analyses suggested a significant decline in the age-adjusted and sex-adjusted prevalence of heart disease (P for trend <0.001) and a non-significant decline in the age-adjusted and sex-adjusted prevalence of stroke (P for trend=0.058) from 2005 to 2016. Nevertheless, the total number of adults suffering from heart disease and stroke increased by 8.9% and 20.2% over the study period, respectively. Moreover, the age-adjusted and sex-adjusted prevalence of heart disease and stroke varied widely across all health regions, and both of them tended be higher among those with lower income. The SII and RII indicated that there were persistent absolute and relative socioeconomic inequalities in heart disease and stroke across all surveys (eg, SII for heart disease in both sexes, 2005: 0.04 (95% CI 0.03 to 0.04); 2015/2016: 0.03 (95% CI, 0.02 to 0.04); RII for heart disease in both sexes, 2005: 1.99 (95% CI 1.75 to 2.27); 2015/2016: 1.77 (95% CI 1.52 to 2.08).
Geographical and socioeconomic disparities should be taken into account during the further efforts to strengthen preventive measures and optimise healthcare resources for heart disease and stroke in Canada.
本研究旨在探讨 2005 年至 2016 年间加拿大心血管疾病（CVD）的地域和社会经济差异的时间趋势和模式。
共纳入 2005 年至 2016 年期间参加加拿大社区健康调查的 67 万≥20 岁成年人。本研究中 CVD 指心脏病和中风。用均等家庭收入作为社会经济地位的替代指标。用不平等斜率指数（SII）和相对不平等指数（RII）分别衡量绝对和相对社会经济不平等。
2015/2016 年，心脏病和中风的总体年龄调整和性别调整患病率分别为 4.80%（95%CI 4.61%至 4.98%）和 1.25%（95%CI 1.13%至 1.36%）。趋势分析表明，从 2005 年到 2016 年，心脏病的年龄调整和性别调整患病率显著下降（趋势 P<0.001），而中风的年龄调整和性别调整患病率无显著下降（趋势 P=0.058）。然而，在研究期间，患心脏病和中风的成年人总数分别增加了 8.9%和 20.2%。此外，所有卫生区域的心脏病和中风的年龄调整和性别调整患病率差异很大，两者在收入较低的人群中往往更高。SII 和 RII 表明，在所有调查中，心脏病和中风都存在持续的绝对和相对社会经济不平等（例如，两性心脏病的 SII，2005 年：0.04（95%CI 0.03 至 0.04）；2015/2016 年：0.03（95%CI，0.02 至 0.04）；两性心脏病的 RII，2005 年：1.99（95%CI 1.75 至 2.27）；2015/2016 年：1.77（95%CI 1.52 至 2.08）。
在加拿大进一步加强预防措施和优化医疗保健资源以治疗心脏病和中风的努力中，应考虑到地理和社会经济差异。
