教育程度与缺血性心力衰竭患者预后的关系  

Association of education level and prognosis in patients with ischemic heart failure

作　　者：徐兰 夏爽 何旭瑜 吴泽佳[2,3] 陈文中 丘伟达 肖小菊 蔡安平 黎励文[1,2,3] XU Lan;XIA Shuang;HE Xu-yu;WU Ze-jia;CHEN Wen-zhong;QIU Wei-da;XIAO Xiao-ju;CAI An-ping;LI Li-wen(School of Medicine,South China University of Technology,Guangzhou 510100,China;Guangdong Provin-cial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China;Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]华南理工大学医学院,广州510110 [2]广东省人民医院(广东省医学科学院),广州510100 [3]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2021年第3期313-319,共7页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金(项目编号:A2017293);广东省人民医院临床研究基金(项目编号:Y012018085);广东省科技计划项目(项目编号:2017B030314041)。

摘　　要：目的评估教育程度对缺血性心力衰竭患者病死率的影响。方法连续纳入2016年1月至2019年6月期间于广东省人民医院心内科诊断为缺血性心力衰竭(ischemic heart failure,IHF)的住院患者,并根据患者的受教育程度分为以下3组:高中及以上组、初中组和小学及以下组,行中位时间2.5年的随访,使用生存模型来评估教育程度与IHF患者病死率之间的关系。结果本研究一共纳入1378例患者,年龄64(25~89)岁,男女各占84.8%和15.2%。教育学历在高中及以上的患者占29.2%,初中占47.7%,小学及以下占23.1%。在未校正分析中,教育学历高低与病死率相关(小学及以下组vs.高中及以上组的HR=1.597,95%CI:1.071~2.381;初中组vs.高中及以上组的HR=1.522,95%CI:1.082~2.141)。调整人口统计学和心血管危险因素后,教育与病死率间相关系数降低,差异无统计学意义(小学及以下组vs.高中及以上组的HR=1.251,95%CI:0.811~1.930;初中组vs.高中及以上组的HR=1.216,95%CI:0.847~1.745)。结论教育程度偏高的IHF患者生存率较高,多变量调整后两者之间联系减弱。应对教育不平等带来的IHF预后差异,公共卫生部门应更关注初等教育及以下这一患者群体的健康保障。Objectives To evaluate the effect of education on mortality in patients with ischemic heart failure(IHF).Methods In this study,patients diagnosed as IHF in Guangdong Provincial People′s Hospital from January 2016 to June 2019 were continuously included.Educational attainment was categorized as:senior high school and above group,junior high school group and primary school or illiterate group.We used survival models to assess the relationship between education and all-cause mortality,both unadjusted and after adjustment for demographic characteristics and cardiovascular risk factors.Results A total of 1378 patients were included in this study.The median age of all the patients was 64(25-89)years,84.8%of males and 15.2%of females.The patients with senior high school education and above accounted for 29.2%,junior high school for 47.7%and primary school or illiterate for 23.1%.In the unadjusted analysis,educational attainment was associated with mortality(primary school or illiterate group vs.senior high school and above group HR=1.597,95%CI:1.071-2.381;junior high school group vs.senior high school and above group HR=1.522,95%CI:1.082-2.141).After adjustment for demographic and cardiovascular risk factors,the association between education and death was further reduced and no longer statistically significant(primary school or illiterate group vs.senior high school and above group HR=1.251,95%CI:0.811-1.930;junior high school group vs.senior high school and above group HR=1.216,95%CI:0.847-1.745).Conclusions Higher education patients with IHF had higher survival rates,while multivariable adjustment weakened the association.To cope with the difference in IHF prognosis caused by educational inequality,the public health department should pay more attention to the health protection of the patients with primary education or less.

关 键 词：心力衰竭 教育程度 病死率 

分 类 号：R541.6[医药卫生—心血管疾病]