Ross Arena, Nicolaas P. Pronk, Elie Gertner, Kharma C Foucher, Colin Woodard
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引用次数: 0
摘要
导言:美国国内的健康指数差异很大,有明显的 "带状和震中",在这些地方,不健康的生活方式行为、慢性疾病和残疾的发病率都很高。关节炎是罹患慢性疾病的一个重要、公认的风险因素。在本文中,我们假设美国关节炎的发病率和发病模式将与全国其他主要健康问题的发病率和发病模式如出一辙。研究方法我们合并了有关关节炎、残疾和抑郁症患病率的县级数据、生活方式健康指数 (LHI)、社会脆弱性指数 (SVI) 和美国民族地区文化图表。结果:我们获得了来自美国 3073 个县的数据。我们发现,年龄调整后的关节炎患病率与(1) LHI 分项得分和总分;(2) 抑郁症患病率;(3) 残疾患病率;(4) SVI 具有显著的统计学意义和普遍较强的皮尔逊乘积相关性(r ≈ 0.70, P < 0.001)。根据美洲民族地区文化模型,年龄调整后关节炎患病率的地理分布在各地区之间存在明显的异质性。结论美国的人口健康状况令人担忧,而目前的医疗保健服务模式往往是从孤立的(特定病症与整体护理)、反应性的二级预防模式出发,不足以应对挑战。
Arthritis in the Regional Cultures of the American Nations: An Overlooked Component of a Larger Unhealthy Lifestyle Syndemic
Introduction: Health indices vary widely within the United States (U.S.), with clear “belts and epicenters” where the prevalence of unhealthy lifestyle behaviors, chronic disease, and disability are all high. Arthritis is a significant, well-established risk factor for developing chronic disease. In this paper, we hypothesize that the prevalence and patterns of arthritis in the U.S. will mirror that of other leading health issues across the country. Methods: We merged county-level data on arthritis, disability, and depression prevalence, the Lifestyle Health Index (LHI), the Social Vulnerability Index (SVI) and the American Nations regional cultures schematic. Results: Data was available from 3073 U.S. counties. We found age-adjusted arthritis prevalence has statistically significant and generally strong Pearson product correlations (r ≈ 0.70, P < 0.001) with (1) LHI sub scores and overall score; (2) Depression prevalence; (3) Disability prevalence; and (4) SVI. The geographic distribution of age-adjusted arthritis prevalence according to the American Nations regional cultures model demonstrated clear heterogeneity across regions. Conclusions: The status of population health in the U.S. is disconcerting and the current model of health care delivery, which is often approached from a siloed (condition-specific vs holistic care), reactionary, secondary prevention model, is inadequate to the challenge.