Socioeconomic factors, health behaviors, and mortality - Results from a nationally representative prospective study of US adults
Socioeconomic factors, health behaviors, and mortality - Results from a nationally representative prospective study of US adults
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DOI：
10.1001/jama.279.21.1703
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发表时间：
1998-06-03
影响因子：
120.7
通讯作者：
Chen, JM
中科院分区：
文献类型：
--
作者：
Lantz, PM;House, JS;Chen, JM
背景。-关于死亡率的社会不平等的一个突出假设是，社会经济弱势群体的风险增加主要是由于教育和收入水平较低的人中健康风险行为的流行率较高。调查4种行为风险因素（吸烟、饮酒、久坐不动的生活方式和相对体重）在多大程度上解释了社会经济特征与全因死亡率之间观察到的关联。纵向调查研究调查教育，收入和健康行为对未来7.5年内死亡风险的影响。一个全国代表性的样本3617成年妇女和男子参加了美国人的生活变化调查。通过国家死亡指数和死亡证明审查核实的全因死亡率。教育与收入之间的密切联系充分解释了死亡率的教育差异。在控制了年龄、性别、种族、城市化程度和教育程度后，最低收入组和中等收入组的死亡风险率比分别为3.22（95%置信区间[CI]，2.01-5.16）和2.34（95% CI，1.49-3.67）。当考虑健康危险行为时，最低收入组（风险率比，2.77; 95%CI，1.74-4.42）和中等收入组（风险率比，2.14; 95%CI，1.38-3.25）的死亡风险仍然显著升高。虽然降低低收入人群中健康风险行为的流行率是一个重要的公共卫生目标，但死亡率的社会经济差异是由更广泛的因素造成的，因此，即使弱势群体的健康行为有所改善，这种差异也会持续存在。
Context.-A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income.Objective.-To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and all-cause mortality.Design.-Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years.Participants.-A nationally representative sample of 3617 adult women and men participating in the Americans' Changing Lives survey.Main Outcome Measure.-All-cause mortality verified through the National Death Index and death certificate reviews.Results.-Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowest-income group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25).Conclusion.-Although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.