Bosma H, Appels A, Sturmans F, Grabauskas V, Gostautas A
Department of Medical Psychology, University of Limburg, Maastricht, The Netherlands.
Int J Epidemiol. 1994 Feb;23(1):12-9. doi: 10.1093/ije/23.1.12.
A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided an opportunity to compare mortality patterns and rates in a population from Lithuania, one of the former republics of the Soviet Union, with a population from the Netherlands. These populations consisted of 2452 and 3365 males, respectively, aged 45-60 years. In 1972-1974, these males were extensively screened for cardiovascular risk factors, using uniform methods.
During the follow-up, 303 males in Kaunas (Lithuania) and 350 males in Rotterdam (the Netherlands) died. Using Cox proportional hazards and logistic regression analysis, it was found that all-cause mortality rates during follow-up were 30% higher in Kaunas; this was mainly due to higher mortality rates from external causes (relative risk = 6.69), stomach cancer (RR = 2.78), stroke (RR = 2.30) and infectious diseases (RR = 12.43). The risk of fatal and non-fatal coronary heart disease (CHD) was, however, smaller in Kaunas (RR = 0.72). This lower risk closely corresponded with the Lithuanian risk profile which could be described by less smoking, lower cholesterol levels, and higher physical activity. As Lithuanians had a more advantageous cardiovascular risk profile, the higher Lithuanian all-cause mortality rates could not be explained by this risk profile.
The results provide evidence for geographical differences in mortality and morbidity between Lithuania and the Netherlands. Population-specific health behaviours were shown to be involved in differences in the risk of CHD. The lower CHD rates in Eastern European communities in the 1970s, in this study confirmed for Lithuania, suggests that the apex of the CHD epidemic had not yet reached the Lithuanian population.
考纳斯-鹿特丹干预研究（KRIS）的9.5年随访提供了一个机会，可对比来自立陶宛（前苏联加盟共和国之一）与荷兰人群的死亡率模式和死亡率。这些人群分别由2452名和3365名年龄在45至60岁的男性组成。1972年至1974年期间，使用统一方法对这些男性进行了广泛的心血管危险因素筛查。
随访期间，考纳斯（立陶宛）的303名男性和鹿特丹（荷兰）的350名男性死亡。通过Cox比例风险模型和逻辑回归分析发现，随访期间考纳斯的全因死亡率高出30%；这主要是由于外部原因（相对风险=6.69）、胃癌（RR=2.78）、中风（RR=2.30）和传染病（RR=12.43）导致更高的死亡率。然而，考纳斯致命和非致命冠心病（CHD）的风险较小（RR=0.72）。这种较低风险与立陶宛人的风险特征密切相关，其特征表现为吸烟较少、胆固醇水平较低和身体活动较多。由于立陶宛人的心血管风险特征更为有利，因此立陶宛较高的全因死亡率无法用该风险特征来解释。
研究结果为立陶宛和荷兰在死亡率和发病率方面的地理差异提供了证据。特定人群的健康行为被证明与冠心病风险差异有关。本研究中针对立陶宛证实的20世纪70年代东欧社区较低的冠心病发病率表明，冠心病流行高峰尚未波及立陶宛人群。
