确定的风险因素对社会决定因素与心血管疾病死亡率之间的关联的调解效应
William J He1, Siyi Geng2, Ling Tian3
1Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
JACC. Advances
|May 8, 2025
概括
健康的社会决定因素 (SDOH) 显著增加心血管疾病 (CVD) 死亡风险. 行为和临床因素部分解释了这种联系,突出了针对性卫生干预措施减少心血管疾病死亡的领域.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 心血管医学 心血管医学
背景情况:
- 健康的社会决定因素 (SDOH) 是已知的导致心血管疾病 (CVD) 死亡率升高的因素.
- 了解SDOH影响心血管疾病死亡率的途径对于制定有效的公共卫生战略至关重要.
研究的目的:
- 调查行为和临床风险因素在多大程度上调解SDOH和心血管疾病死亡率之间的关联.
- 量化特定风险因素对SDOH-CVD死亡率关系的贡献.
主要方法:
- 来自国家健康和营养检查调查 (NHANES) 的大量队列 (n=50,808) 的分析,对心血管疾病死亡的长期随访.
- 利用多重调解分析来评估SDOH通过行为和临床因素对心血管疾病死亡率的间接影响.
- 收集了关于社会,行为和临床风险因素的数据,并将其与国家死亡指数联系起来,以确定到2019年的死亡率.
主要成果:
- 在SDOH和心血管疾病死亡率之间观察到剂量反应关系.
- 具有较高SDOH分数的个体具有显著增加的心血管疾病死亡风险,在考虑行为和临床因素后,这种风险降低了.
- 目前的吸烟,身体不活动,慢性病,糖尿病和不健康的睡眠时间被确定为重要的调解因素,共同解释了与不利的SDOH相关的30.8%的心血管疾病死亡风险.
结论:
- 行为和临床风险因素在与不良的健康社会决定因素相关的高心血管疾病死亡率中起着部分调解作用.
- 这些发现强调了解决社会和个人层面的风险因素的重要性,以减轻心脏病死亡率.
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