Socio-economic trajectories and cardiovascular disease mortality in older people: the English Longitudinal Study of Ageing.
Socio-economic trajectories and cardiovascular disease mortality in older people: the English Longitudinal Study of Ageing.
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DOI：
10.1093/ije/dyx106
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发表时间：
2018-02-01
影响因子：
7.7
通讯作者：
Batty GD
中科院分区：
文献类型：
--
作者：
Stringhini S;Zaninotto P;Kumari M;Kivimäki M;Lassale C;Batty GD
早年的社会经济地位与心血管疾病风险有关，但生命过程社会经济轨迹的影响以及心血管疾病风险社会不平等的机制尚不确定。我们评估了行为、心理社会和生理(包括炎症)因素在老年人生命过程社会经济状况和心血管疾病死亡率之间的关系中的作用。参与者是英国老龄化纵向研究的7,846人(44%为女性)，该研究于2002年至2003年建立，是对年龄为50岁的个人的代表性研究。包括四个社会经济地位指标(父亲的社会阶层、自己的教育程度、职业地位和财富)，我们计算了一个社会经济轨迹指数和一生累计社会经济得分。行为因素(吸烟、体力活动、饮酒、体重指数)和心理社会因素(社会关系、孤独感)、生理因素(血压、总胆固醇、甘油三酯)和炎症标记物(C反应蛋白、纤维蛋白原)是潜在的解释变量。心血管疾病死亡率是通过研究成员与国家死亡率登记的联系来确定的。调解是用传统的“估计变动法”计算的，在这方面不能采用反事实调解模型等替代办法。在长达8.4年的随访中，1301名研究成员死亡(438名死于心血管疾病)。与一生中稳定的高社会阶层相比，稳定的低社会阶层轨迹与心血管疾病死亡率(风险比；95%可信区间：1.94，1.37；2.75)的风险大约是前者的两倍。生命过程累积社会经济地位最高组中最低的个人死于心血管疾病的可能性也是最高组的两倍多(2.57，1.81；3.65)。行为因素和炎症标记物对这种梯度的解释作用最大，而心理社会和其他生理风险因素的作用不大。在生活在英格兰的一组老年人群中，我们提供了生命过程中的不利因素与心血管疾病死亡率相关的证据。行为因素和炎症标记物部分解释了这种梯度，这可能会为干预的可能性提供洞察。
Socio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain. We assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults. Participants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002–03. Comprising four indicators of socio-economic status (father’s social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional ‘change-in-estimate method’ and alternative approaches such as counterfactual mediation modelling could not be applied in this context. During the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest. In a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention.
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影响因子：
7.7
作者：
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通讯作者：
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