Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke.
Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke.
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DOI：
10.1097/ede.0b013e31824570bd
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
VanderWeele TJ
中科院分区：
文献类型：
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作者：
Nandi A;Glymour MM;Kawachi I;VanderWeele TJ
早期社会经济地位（SES）与成人慢性疾病相关，但目前尚不清楚这种影响是否完全通过成人SES介导，或者是否有不良的早期生活SES对成人疾病的直接影响。评估这些替代方案的主要挑战包括早期生活SES的不精确测量和传统回归方法评估调解的偏见。特别是，传统的回归方法，直接影响估计是有偏见的，当有随时间变化的混杂成人SES和慢性疾病的慢性疾病危险因素之间的关联。首次报告的心脏病，糖尿病和中风诊断是在1992年至2006年每两年对9,760名健康和退休研究参与者进行一次全国抽样评估。使用探索性和验证性因素分析得出的早期生活和成人SES措施。早期社会经济地位是衡量父母的教育，父亲的职业，出生地区，和童年农村居住。成人社会经济地位是衡量受访者的教育，职业，劳动力状况，家庭收入和家庭财富。使用边际结构模型，我们估计了早期生活SES对慢性疾病发作的直接影响，而不是由成人SES介导的。边缘结构模型采用稳定的逆概率加权对数线性模型进行估计，以调整可能混淆成人SES和慢性疾病之间关联的风险因素。在随访期间，分别有24%、18%和9%的参与者首次出现心脏病、糖尿病和中风。比较最弱势和最弱势的四分位数，早期SES与CHD（风险比=1.30 [95%置信区间= 1.12-1.51]）和糖尿病（1.23 [1.02-1.48]）相关，并通过成人SES不介导的途径与卒中轻微相关。我们的研究结果表明，早期的社会经济经历直接影响成人慢性病的结果。
Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors. First-reported heart disease, diabetes and stroke diagnoses were assessed in a national sample of 9,760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father’s occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent’s education, occupation, labor force status, household income, and household wealth. Using marginal structural models we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse-probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease. During follow-up, 24%, 18%, and 9% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged to the least disadvantaged quartile, early-life SES was associated with CHD (risk ratio=1.30 [95% confidence interval= 1.12–1.51]) and diabetes (1.23 [1.02–1.48]) and marginally associated with stroke via pathways not mediated by adult SES. Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.