Social Class, Risk Factors, and Stroke Incidence in Men and Women A Prospective Study in the European Prospective Investigation Into Cancer in Norfolk Cohort
Social Class, Risk Factors, and Stroke Incidence in Men and Women A Prospective Study in the European Prospective Investigation Into Cancer in Norfolk Cohort
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DOI：
10.1161/strokeaha.108.533414
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发表时间：
2009-04-01
期刊：
影响因子：
8.3
通讯作者：
Khaw, Kay-Tee
中科院分区：
文献类型：
--
作者：
McFadden, Emily;Luben, Robert;Khaw, Kay-Tee
背景和目的-本研究的目的是调查职业社会阶层和中风发病率之间的关系，以及经典、生活方式和心理社会危险因素在多大程度上可以解释这种关系。方法-对22488名年龄在39至79岁之间的男性和女性进行了前瞻性人群研究，这些男性和女性生活在英国诺福克的普通社区，结果：社会等级与卒中发病率呈负相关，经年龄和性别校正的社会等级V与I的危险比为2.62（95%CI，1.63 ~ 4.22; P=0.001）。为古典音乐做调整（收缩压、总血胆固醇、吸烟、糖尿病史和体重指数）、生活方式（血浆维生素C水平，酒精摄入量和体力活动），以及心理社会（5项版本的心理健康清单）风险因素影响不大，社会经济差异仍然明显：社会等级V与I的风险比为2.55（95%CI，1.34 - 4.85，V与I比较P=0.004）结论：无论男性还是女性，卒中发病率均随社会等级的降低而增加。校正一系列的经典、生活方式和社会心理危险因素并不能解释卒中发病率的社会经济差异。如果我们要减少健康方面的不平等，就需要进一步了解这种关联的机制。（中风。2009;40：1070-1077）。
Background and Purpose-The purpose of this study was to investigate the association between occupational social class and stroke incidence and the extent to which classical, lifestyle, and psychosocial risk factors may explain such relationships.Methods-A prospective population study was conducted of 22 488 men and women aged 39 to 79 years living in the general community in Norfolk, UK, recruited in 1993 to 1997 and followed up for stroke incidence to 2007.Results-An inverse relationship was observed between social class and stroke incidence with an age- and sex-adjusted hazard ratio for social Class V compared with I of 2.62 (95% CI, 1.63 to 4.22; P=0.001). Adjusting for classical (systolic blood pressure, total blood cholesterol, smoking, history of diabetes, and body mass index), lifestyle (plasma vitamin C levels, alcohol intake, and physical activity), and psychosocial (5-item version of the Mental Health Inventory) risk factors had little effect, and a socioeconomic differential was still apparent: hazard ratio for social Class V compared with I of 2.55 (95% CI, 1.34 to 4.85, P=0.004 for comparison of V to I)Conclusions-Stroke incidence increased with lower social class in both men and women. Adjustment for a comprehensive range of classical, lifestyle, and psychosocial risk factors did not explain the socioeconomic differential in stroke incidence. If we are to reduce inequalities in health, further understanding of the mechanisms underlying the association is needed. (Stroke. 2009;40:1070-1077.)