Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies.
Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies.
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DOI：
10.1136/bmj.n604
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发表时间：
2021-04-14
期刊：
影响因子：
--
通讯作者：
Pan A
中科院分区：
文献类型：
--
作者：
Zhang YB;Chen C;Pan XF;Guo J;Li Y;Franco OH;Liu G;Pan A
研究整体生活方式是否介导社会经济地位 (SES) 与死亡率和心血管疾病 (CVD) 事件的关联，以及生活方式和 SES 与健康结果的相互作用或联合关系的程度。基于人群的队列研究。美国国家健康和营养检查调查（美国 NHANES，1988-94 和 1999-2014）和英国生物银行。 44 462 名 20 岁或以上的美国成年人和 399 537 名 37-73 岁的英国成年人。 SES是通过潜在类别分析，利用家庭收入、职业或就业状况、教育水平和健康保险（仅限美国NHANES）得出的，并根据项目响应概率定义三个级别（低、中和高）。健康生活方式评分是根据从不吸烟、不大量饮酒（女性每天≤1 杯；男性每天≤2 杯；美国一杯酒精含量为 14 克，英国酒精含量为 8 克）、身体活动排名前三分之一以及较高的饮食质量等信息构建的。全因死亡率是这两项研究的主要结果，而英国生物银行的心血管疾病死亡率和发病率则是通过与登记处的联系获得的。美国 NHANES 在平均随访 11.2 年期间记录了 8906 例死亡，英国生物银行在平均随访 8.8-11.0 年期间记录了 22-309 例死亡和 6903 例 CVD 病例。在低SES成年人中，美国NHANES和英国生物银行的年龄调整死亡风险分别为每1000人年22.5（95%置信区间21.7至23.3）和7.4（7.3至7.6），英国生物银行的年龄调整CVD风险为每1000人年2.5（2.4至2.6）。高SES成年人的相应风险为每1000人年11.4（10.6至12.1）、3.3（3.1至3.5）和1.4（1.3至1.5）。与高 SES 的成年人相比，低 SES 的成年人全因死亡风险更高（美国 NHANES 的风险比为 2.13，95% 置信区间为 1.90 至 2.38；英国生物库为 1.96、1.87 至 2.06）、CVD 死亡率（2.25、2.00 至 2.53）和 CVD 事件风险（1.65、1.52 至 2.53）。英国生物银行的数据显示（1.79），生活方式介导的比例分别为12.3%（10.7%至13.9%）、4.0%（3.5%至4.4%）、3.0%（2.5%至3.6%）和3.7%（3.1%至4.5%）。在美国 NHANES 中，生活方式与 SES 之间没有观察到显着的相互作用，而在英国生物银行中，低 SES 的生活方式与结果之间的关联更强。与具有高 SES 和三到四种健康生活方式因素的成年人相比，低 SES 且没有或没有一种健康生活方式因素的成年人的全因死亡风险较高（美国 NHANES 为 3.53、3.01 至 4.14；英国生物银行为 2.65、2.39 至 2.94）、CVD 死亡率（2.65、2.09 至 3.38）和意外 CVD 风险（2.09、1.78）至 2.46）在英国生物银行。不健康的生活方式在美国和英国成年人健康方面的社会经济不平等中起到了一小部分的作用；因此，仅提倡健康的生活方式可能无法大幅减少健康方面的社会经济不平等，需要采取其他措施来解决健康问题的社会决定因素。然而，健康的生活方式与不同 SES 亚组的较低死亡率和 CVD 风险相关，这支持了健康生活方式在减轻疾病负担方面的重要作用。
To examine whether overall lifestyles mediate associations of socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) and the extent of interaction or joint relations of lifestyles and SES with health outcomes. Population based cohort study. US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank. 44 462 US adults aged 20 years or older and 399 537 UK adults aged 37-73 years. SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality. All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries. US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22 309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank. Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
影响因子：
50
作者：
Foster, Hatnish M. E.;Celis-Morales, Carlos A.;Mair, Frances S.
通讯作者：
Mair, Frances S.
DOI：
10.1111/j.1749-6632.2009.05340.x
发表时间：
2010-01-01
期刊：
BIOLOGY OF DISADVANTAGE: SOCIOECONOMIC STATUS AND HEALTH
影响因子：
--
作者：
Kawachi, Ichiro;Adler, Nancy E.;Dow, William H.
通讯作者：
Dow, William H.
影响因子：
105.7
作者：
Chen, Chen;Ye, Yi;Pan, An
通讯作者：
Pan, An
影响因子：
12.7
作者：
Ford, Earl S.;Zhao, Guixiang;Li, Chaoyang
通讯作者：
Li, Chaoyang