Bobák M, Skodová Z, Písa Z
London School of Hygiene and Tropical Medicine, UK.
Cas Lek Cesk. 1994 Oct 24;133(20):627-32.
Although socioeconomic factors are significant predictors of cardiovascular disease risk, their role has not yet been fully elucidated in our country. The objective of the present work was to find out whether they participate, and to what extent, in cardiovascular diseases.
We re-analyzed data assembled during the second cross-sectional survey of the MONICA project in 1988: the investigated population, comprising 1349 men and 1407 women, was divided into four age groups (25-34, 35-44, 45-54 and 55-64 years) and into three groups by the highest achieved education (elementary, secondary and university). The age specific prevalence of cigarette smoking, obesity (expressed as BMI), serum cholesterol and blood pressure reading by level of education was investigated. While in the younger age groups--consistent with observations in western countries--an inverse correlation between education and risk factors predominates, in the older age groups this relationship is reversed. The contrast between groups by attained education is manifested most markedly in smoking (men, trend p < 0.001), obesity (women, trend p < 0.001), total cholesterol (men, women, the difference is, however, not statistically significant), and systolic blood pressure in men (trend p < 0.001). In all these risk factors the profile is more favourable in subjects with a higher (university) education. An exception is the lower HDL cholesterol level (p < 0.001) in women with elementary education (in men a reversed relationship, but not statistically significant). The contrast between younger and older age groups was manifested most markedly in smoking and obesity.
The observation supports the hypothesis that gradually a change of the socioeconomic gradient of cardiovascular diseases is taking place. The results indicate that subjects with lower education in the younger age groups and subjects with higher education in the older age groups are a population with an unfavourable risk profile on which preventive programmes should be focused in the first place.
尽管社会经济因素是心血管疾病风险的重要预测指标，但在我国其作用尚未得到充分阐明。本研究的目的是探究它们是否以及在多大程度上与心血管疾病相关。
我们重新分析了1988年莫尼卡项目第二次横断面调查收集的数据：调查对象包括1349名男性和1407名女性，分为四个年龄组（25 - 34岁、35 - 44岁、45 - 54岁和55 - 64岁），并根据最高学历分为三组（小学、中学和大学）。研究了按教育程度划分的各年龄组吸烟、肥胖（以体重指数表示）、血清胆固醇和血压读数的患病率。在较年轻的年龄组中——与西方国家的观察结果一致——教育程度与风险因素之间主要呈负相关，而在较年长的年龄组中这种关系则相反。按获得的教育程度分组之间的差异在吸烟（男性，趋势p < 0.001）、肥胖（女性趋势p < 0.001）、总胆固醇（男性和女性，然而差异无统计学意义）以及男性收缩压（趋势p < 0.001）方面表现最为明显。在所有这些风险因素中，受过高等（大学）教育的人群情况更为有利。一个例外是小学学历女性的高密度脂蛋白胆固醇水平较低（p < 0.001）（男性中呈相反关系，但无统计学意义）。年轻和年长年龄组之间的差异在吸烟和肥胖方面表现最为明显。
该观察结果支持了心血管疾病社会经济梯度正在逐渐发生变化这一假设。结果表明，较年轻年龄组中受教育程度较低的人群以及较年长年龄组中受教育程度较高的人群是风险状况不利的人群，预防计划应首先关注这些人群。
