Zhu Yanchen, Wu Shiping, Qiu Weida, Wang Jiabin, Feng Yingqing, Chen Chaolei
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Global Health Research Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
JAMA Netw Open. 2024 Dec 2;7(12):e2451844. doi: 10.1001/jamanetworkopen.2024.51844.
Although cumulative evidence suggests that higher blood pressure (BP) and a greater burden of social determinants of health (SDOH) are associated with an increased risk of stroke, few studies have examined whether SDOH burden modifies the association between BP and stroke risk.
To evaluate whether the association between BP classification and stroke risk differs by SDOH burden among Chinese adults.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, analyses were conducted among 90 850 participants in the prospective subcohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, with recruitment from January 1, 2016, to December 31, 2020. Participants without cardiovascular diseases and with complete data were included and followed up for stroke events until June 30, 2023.
Social determinants of health burden was defined using 5 components: educational attainment, economic stability, health care access, social support, and urban vs rural residence. Blood pressure was categorized according to the 2017 American College of Cardiology/American Heart Association BP guideline.
Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of BP classification with incident stroke stratified by SDOH burden groups.
The study included 90 850 participants (median age, 54.0 years [IQR, 46.0-62.0 years]; 55 390 women [61.0%]). During a median follow-up of 5.0 years (IQR, 4.1-5.8 years), 4408 incident stroke events were recorded. Compared with normal BP, elevated BP (HR, 1.33 [95% CI, 1.17-1.52]), stage 1 hypertension (HR, 1.60 [95% CI, 1.43-1.78]), and stage 2 hypertension (HR, 1.79 [95% CI, 1.61-2.00]) were associated with stroke among participants with high SDOH burden, while only stage 2 hypertension (HR, 1.52 [95% CI, 1.20-1.93]) was associated with stroke among those with low SDOH burden, with a significant multiplicative interaction of SDOH burden and BP classification (P = .03). Participants with high SDOH burden and stage 2 hypertension had the highest risk of stroke compared with participants with low SDOH burden and normal BP (HR, 2.13 [95% CI, 1.75-2.60]).
This study suggests that higher BP levels, even at lower stages of hypertension, pose a greater stroke risk for individuals with high SDOH burden. Early surveillance and intervention for high BP should be emphasized in socioeconomically disadvantaged populations.
尽管累积证据表明，较高的血压（BP）和更大的健康社会决定因素（SDOH）负担与中风风险增加相关，但很少有研究探讨SDOH负担是否会改变BP与中风风险之间的关联。
评估在中国成年人中，BP分类与中风风险之间的关联是否因SDOH负担不同而有所差异。
设计、背景和参与者：在这项队列研究中，对中国心脏事件百万人群项目以患者为中心的评估前瞻性子队列中的90850名参与者进行了分析，招募时间为2016年1月1日至2020年12月31日。纳入无心血管疾病且数据完整的参与者，并随访中风事件直至2023年6月30日。
健康社会决定因素负担由五个部分定义：教育程度、经济稳定性、医疗保健可及性、社会支持以及城乡居住情况。血压根据2017年美国心脏病学会/美国心脏协会的BP指南进行分类。
采用多变量Cox比例风险回归来估计BP分类与按SDOH负担组分层的中风事件之间关联的风险比（HRs）和95%置信区间（CIs）。
该研究纳入90850名参与者（中位年龄54.0岁[四分位间距，46.0 - 62.0岁]；55390名女性[61.0%]）。在中位随访5.0年（四分位间距，4.1 - 5.8年）期间，记录到4408例中风事件。与正常血压相比，在SDOH负担高的参与者中，血压升高（HR，1.33[95%CI，1.17 - 1.52]）、1级高血压（HR，1.60[95%CI，1.43 - 1.78]）和2级高血压（HR，1.79[95%CI，1.61 - 2.00]）与中风相关，而在SDOH负担低的参与者中，只有2级高血压（HR，1.52[95%CI，1.20 - 1.93]）与中风相关，SDOH负担与BP分类之间存在显著的相乘交互作用（P = 0.03）。与SDOH负担低且血压正常的参与者相比，SDOH负担高且患有2级高血压的参与者中风风险最高（HR，2.13[95%CI，1.75 - 2.60]）。
本研究表明，即使在高血压较低阶段，较高的BP水平对SDOH负担高的个体构成更大的中风风险。应在社会经济弱势群体中强调对高血压的早期监测和干预。
