Socioeconomic Deprivation and the Incidence of 12 Cardiovascular Diseases in 1.9 Million Women and Men: Implications for Risk Prediction and Prevention
Socioeconomic Deprivation and the Incidence of 12 Cardiovascular Diseases in 1.9 Million Women and Men: Implications for Risk Prediction and Prevention
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DOI：
10.1371/journal.pone.0104671
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发表时间：
2014-08-21
期刊：
影响因子：
3.7
通讯作者：
Hemingway, Harry
中科院分区：
文献类型：
--
作者：
Pujades-Rodriguez, Mar;Timmis, Adam;Hemingway, Harry
背景资料：最近的实验证据表明，社区的社会经济特征影响心血管健康，但观察性研究，检查剥夺了广泛的心血管疾病（心血管疾病）是lacking.Methods：记录联动队列研究的193万人，研究小面积的社会经济剥夺和12心血管疾病之间的关联。健康记录包括初级保健、住院、心肌梗死登记和英格兰的病因特异性死亡率（CALIBER）。患者年龄>= 30岁，最初无CVD。考克斯比例风险模型分层的一般practicewere used.Findings：在中位数为5.5年的后续114,859人有12个初始CVD介绍之一。在女性中，除腹主动脉瘤外，所有心血管疾病的风险均随小区域社会经济贫困程度的增加而线性增加（腹主动脉瘤的调整后HR为1.05，95%CI 0.83-1.32，心力衰竭的调整后HR为1.55，95%CI 1.42-1.70; I-2 = 81.9%，tau（2）= 0.01）。在男性中异质性更高（HR范围为0.89，95%CI 0.75-1.06（心脏骤停）至1.85，95%CI 1.67-2.04（外周动脉疾病）; I-2 = 96.0%，tau（2）= 0.06），未观察到与稳定型心绞痛、心源性猝死、蛛网膜下腔出血、短暂性脑缺血发作和腹主动脉瘤相关。在女性中，最贫困和最贫困五分位数之间的终生风险差异在外周动脉疾病方面最为显著（4.3%最贫困，5.8%最贫困）和男子（4.6%最不贫困，7.8%最贫困）;但心脏性猝死，短暂性脑缺血发作，腹主动脉瘤和缺血性和脑内出血，在女性和男性都很小或可以忽略不计。小面积的社会经济贫困与12种心血管疾病的关联是异质的，并且在男性中没有几种疾病。研究结果表明，减少剥夺的政策可能对心力衰竭和外周动脉疾病的影响更大，并且可能对女性更有效。
Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.Methods: Record-linkage cohort study of 1.93 million people to examine the association between small-area socioeconomic deprivation and 12 CVDs. Health records covered primary care, hospital admissions, a myocardial infarction registry and cause-specific mortality in England (CALIBER). Patients were aged >= 30 years and were initially free of CVD. Cox proportional hazard models stratified by general practice were used.Findings: During a median follow-up of 5.5 years 114,859 people had one of 12 initial CVD presentations. In women the hazards of all CVDs except abdominal aortic aneurysm increased linearly with higher small-area socioeconomic deprivation (adjusted HR for most vs. least deprived ranged from 1.05, 95%CI 0.83-1.32 for abdominal aortic aneurysm to 1.55, 95%CI 1.42-1.70 for heart failure; I-2 = 81.9%, tau(2) = 0.01). In men heterogeneity was higher (HR ranged from 0.89, 95%CI 0.75-1.06 for cardiac arrest to 1.85, 95%CI 1.67-2.04 for peripheral arterial disease; I-2 = 96.0%, tau(2) = 0.06) and no association was observed with stable angina, sudden cardiac death, subarachnoid haemorrhage, transient ischaemic attack and abdominal aortic aneurysm. Lifetime risk difference between least and most deprived quintiles was most marked for peripheral arterial disease in women (4.3% least deprived, 5.8% most deprived) and men (4.6% least deprived, 7.8% in most deprived); but it was small or negligible for sudden cardiac death, transient ischaemic attack, abdominal aortic aneurysm and ischaemic and intracerebral haemorrhage, in both women and men.Conclusions: Associations of small-area socioeconomic deprivation with 12 types of CVDs were heterogeneous, and in men absent for several diseases. Findings suggest that policies to reduce deprivation may impact more strongly on heart failure and peripheral arterial disease, and might be more effective in women.