Wealth and mortality at older ages: a prospective cohort study
Wealth and mortality at older ages: a prospective cohort study
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DOI：
10.1136/jech-2015-206173
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发表时间：
2016-04-01
影响因子：
6.3
通讯作者：
Marmot, Michael G.
中科院分区：
文献类型：
--
作者：
Demakakos, Panayotes;Biddulph, Jane P.;Marmot, Michael G.
背景：尽管社会经济地位对生存很重要，但总财富--一种衡量一生中资产积累的指标--作为死亡率的预测因子，一直被研究得很少。我们调查了总财富与老年死亡率之间的关系。方法我们使用来自英国老龄化纵向研究的10305名50岁社区居民的样本来估计COX比例风险模型。结果在平均9.4年的随访中，观察到2401例死亡。在50-64岁的参与者中，与最高财富三分位数相比，中等和最低财富三分位数的完全调整死亡率比分别为1.21(95%可信区间0.92~1.59)和1.77(1.35~2.33)。心血管疾病死亡率分别为2.54(1.27~5.09)和3.73(1.86~7.45)，其他非癌症死亡率分别为1.36(0.76~2.42)和2.53(1.45~4.41)。在完全调整的模型中，财富与癌症死亡率无关。在65岁的参与者中也观察到了类似但不那么强烈的关联。对财富和协变量的重复测量只带来了很小的变化，除了财富和心血管死亡率之间的关联，这种关联在年轻参与者中变得不那么强烈。财富解释了14岁时父亲职业、教育程度、职业阶层、收入和死亡率之间的关系。结论在老年死亡率方面存在持续的财富不平等，这种不平等只能部分地由既定的危险因素来解释。与其他社会经济地位指标相比，财富与死亡率的关联性似乎更强。
Background Despite the importance of socioeconomic position for survival, total wealth, which is a measure of accumulation of assets over the life course, has been underinvestigated as a predictor of mortality. We investigated the association between total wealth and mortality at older ages.Methods We estimated Cox proportional hazards models using a sample of 10305 community-dwelling individuals aged 50years from the English Longitudinal Study of Ageing.Results 2401 deaths were observed over a mean follow-up of 9.4years. Among participants aged 50-64years, the fully adjusted HRs for mortality were 1.21 (95% CI 0.92 to 1.59) and 1.77 (1.35 to 2.33) for those in the intermediate and lowest wealth tertiles, respectively, compared with those in the highest wealth tertile. The respective HRs were 2.54 (1.27 to 5.09) and 3.73 (1.86 to 7.45) for cardiovascular mortality and 1.36 (0.76 to 2.42) and 2.53 (1.45 to 4.41) for other non-cancer mortality. Wealth was not associated with cancer mortality in the fully adjusted model. Similar but less strong associations were observed among participants aged 65years. The use of repeated measurements of wealth and covariates brought about only minor changes, except for the association between wealth and cardiovascular mortality, which became less strong in the younger participants. Wealth explained the associations between paternal occupation at age 14years, education, occupational class, and income and mortality.Conclusions There are persisting wealth inequalities in mortality at older ages, which only partially are explained by established risk factors. Wealth appears to be more strongly associated with mortality than other socioeconomic position measures.