Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women.
Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women.
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DOI：
10.1016/s0140-6736(16)32380-7
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发表时间：
2017-03-25
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影响因子：
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通讯作者：
LIFEPATH consortium
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文献类型：
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作者：
Stringhini S;Carmeli C;Jokela M;Avendaño M;Muennig P;Guida F;Ricceri F;d'Errico A;Barros H;Bochud M;Chadeau-Hyam M;Clavel-Chapelon F;Costa G;Delpierre C;Fraga S;Goldberg M;Giles GG;Krogh V;Kelly-Irving M;Layte R;Lasserre AM;Marmot MG;Preisig M;Shipley MJ;Vollenweider P;Zins M;Kawachi I;Steptoe A;Mackenbach JP;Vineis P;Kivimäki M;LIFEPATH consortium
2011年，世卫组织成员国签署了25 × 25倡议，这是一项到2025年将非传染性疾病死亡率降低25%的计划。然而，影响非传染性疾病的社会经济因素未列入该计划。在这项研究中，我们旨在比较社会经济地位对死亡率和寿命损失年的贡献与25 × 25常规危险因素的贡献。我们对来自世卫组织7个高收入成员国的1 751 479人（54%为女性）进行了多队列研究和荟萃分析，纳入了来自48项独立前瞻性队列研究的个人数据，其中包含社会经济地位信息，以职业职位、25 × 25风险因素（高酒精摄入量、缺乏身体活动、目前吸烟、高血压、糖尿病和肥胖）和死亡率为索引。我们通过计算最低调整和相互调整的危险比[HR]和95% ci，估计社会经济地位和25 × 25危险因素与全因死亡率和原因特异性死亡率的关系。我们还估计了由于次优风险因素导致的人口归因比例和寿命损失年数。在2660万人年的风险中（平均随访13.3年[SD 6.4年]），310277名参与者死亡。25 × 25危险因素和死亡率的HR在男性肥胖的1.04 （95% CI 0.98 - 1.11）和男性吸烟的2.17（2.06 - 2.29）之间变化。社会经济地位低的受试者死亡率高于社会经济地位高的受试者（男性HR为1.42,95% CI为1.38 - 1.45；女性为1.34,1.28 - 1.39）；在包含25 × 25因素的相互调整模型中，这种关联仍然显著（HR为1.26，男性和女性合计为1.21 - 1.32）。人口归因比例最高的是吸烟，其次是缺乏运动，然后是社会经济地位。在40至85岁之间，低社会经济地位与预期寿命减少2.1年相关，相应的寿命损失年数为：高酒精摄入者0.5年，肥胖者0.7年，糖尿病者3.9年，高血压者1.6年，缺乏身体活动者2.4年，吸烟者4.8年。除了25 × 25因素外，地方和全球卫生战略和健康风险监测还应将社会经济环境作为降低死亡率的目标。欧洲委员会、瑞士国家教育秘书处、瑞士国家科学基金会、医学研究理事会、北福斯克、葡萄牙科学和技术基金会。
In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98–1·11) for obesity in men and 2 ·17 (2·06–2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38–1·45 for men; 1·34, 1·28–1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21–1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.