Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study
Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study
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DOI：
10.1136/bmj.d3785
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发表时间：
2011-06-28
影响因子：
105.7
通讯作者：
Watt, Graham C. M.
中科院分区：
文献类型：
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作者：
Hart, Carole L.;Gruer, Laurence;Watt, Graham C. M.
目的探讨死亡原因，社会地位和肥胖之间的关系，在妇女谁从来没有smoked.Design前瞻性队列研究。设置伦弗鲁和佩斯利，Scotland.Participants 8353名妇女和7049名男子年龄在45-64被招募到伦弗鲁和佩斯利研究在1972年至1976年。其中，3613名妇女从未吸烟，是这项研究的重点。他们被按职业分类（I和II、III非手动、III手动以及IV和V）和体重指数组（正常体重、超重、中度肥胖和严重肥胖）。主要结果测量在28年随访期间，职业类别和体重指数的所有原因和原因特异性死亡率，使用考克斯比例风险模型校正年龄和其他混杂因素。结果从不吸烟的低职业阶层妇女平均身高较低，肺功能较差，收缩压高于妇女在高级职业中的地位。总体而言，43%（n=1555）超重，14%（n=515）中度肥胖，5%（n=194）重度肥胖。肥胖率在较低的职业类别中较高，在所有职业类别中均远高于整个队列中目前吸烟者的肥胖率。一半的妇女死亡，51%（n=916）死于心血管疾病，27%（n=487）死于癌症。相对于职业I类和II类，职业III类（相对死亡率1.35，95%置信区间1.16 ~ 1.57）和职业IV类和职业V类（1.34，1.17 ~ 1.55）的全因死亡率高出三分之一以上，这在很大程度上是由肥胖、收缩压和肺功能的差异解释的。心血管疾病和呼吸系统疾病也有类似的上升趋势，但癌症没有。死亡率最高的严重肥胖的妇女在最低的职业class.Conclusions从不吸烟，不肥胖的妇女有最低的死亡率，无论他们的社会地位。如果肥胖是社会模式，如在这个队列中，它可能会导致健康不平等，并增加对健康和社会服务的压力，为更多的弱势群体服务。
Objective To investigate the relations between causes of death, social position, and obesity in women who had never smoked.Design Prospective cohort study.Setting Renfrew and Paisley, Scotland.Participants 8353 women and 7049 men aged 45-64 were recruited to the Renfrew and Paisley Study in 1972-6. Of these, 3613 women had never smoked and were the focus of this study. They were categorised by occupational class (I and II, III non-manual, III manual, and IV and V) and body mass index groups (normal weight, overweight, moderately obese, and severely obese).Main outcome measures All cause and cause specific mortality during 28 years of follow-up by occupational class and body mass index, using Cox proportional hazards models adjusted for age and other confounders.Results The women in lower occupational classes who had never smoked were on average shorter and had poorer lung function and higher systolic blood pressure than women in the higher occupational classes. Overall, 43% (n=1555) were overweight, 14% (n=515) moderately obese, and 5% (n=194) severely obese. Obesity rates were higher in lower occupational classes and much higher in all occupational classes than in current smokers in the full cohort. Half the women died, 51% (n=916) from cardiovascular disease and 27% (n=487) from cancer. Relative to occupational class I and II, all cause mortality rates were more than a third higher in occupational classes III manual (relative rate 1.35, 95% confidence interval 1.16 to 1.57) and IV and V (1.34, 1.17 to 1.55) and largely explained by differences in obesity, systolic blood pressure, and lung function. Similar upward gradients were seen for cardiovascular disease and respiratory disease but not for cancer. Mortality rates were highest in severely obese women in the lowest occupational classes.Conclusions Women who had never smoked and were not obese had the lowest mortality rates, regardless of their social position. Where obesity is socially patterned as in this cohort, it may contribute to health inequalities and increase pressure on health and social services serving more disadvantaged populations.