Lifetime socioeconomic position and mortality: Prospective observational study
Lifetime socioeconomic position and mortality: Prospective observational study
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DOI：
10.1136/bmj.314.7080.547
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发表时间：
1997-02-22
影响因子：
105.7
通讯作者：
Hawthorne, V
中科院分区：
文献类型：
--
作者：
Smith, GD;Hart, C;Hawthorne, V
目的：评估一生中社会经济地位对心血管疾病危险因素、发病率和各种原因死亡率的影响。设计：前瞻性观察研究，随访 21 年。社会阶层在参与者一生的三个阶段被确定为手工或非手工：从他们父亲工作的社会阶层，他们第一份工作的社会阶层，以及筛选时他们工作的社会阶层。构建了累积社会阶层指标，范围从人生所有三个阶段的非体力社会阶层到所有三个阶段的体力社会阶层。地点：苏格兰西部的 27 个工作场所。参与者：5766 名检查时年龄在 35-64 岁的男性。主要成果衡量标准。心血管疾病危险因素的患病率和水平、发病率和广泛死亡原因的死亡率。结果：从所有三个生命阶段的非体力劳动社会阶层位置到所有阶段的体力劳动，血压、体重指数、当前吸烟、心绞痛和支气管炎均呈强烈的正趋势。身高、胆固醇浓度、肺功能和戒烟情况则呈相反趋势。 1580 名男子在随访期间死亡。与非体力社会阶层的男性相比，在生命的所有三个阶段，年龄调整后的相对死亡率在两个非体力社会阶层和一个体力社会阶层的男性中为 1.29（95% 置信区间为 1.08 至 1.56）；两个体力社会阶层和一个非体力社会阶层的男性为 1.45（1.21 至 1.73）；在所有三个阶段，体力劳动社会阶层的男性为 1.71（1.46 至 2.01）。心血管疾病死亡率与累积社会阶层表现出类似的分级相关性。癌症死亡率主要在所有三个阶段的体力劳动社会阶层的男性中增加。对各种危险因素进行调整后，累积社会阶层与全因死亡率和心血管疾病死亡率之间的关联几乎没有减弱；与非心血管、非癌症疾病死亡率的相关性有更大的减弱，从事非体力职业的父亲与心血管疾病死亡率密切相关：相对比率1.41（1.15至1.72）。与其他社会阶层指标相比，参与者在筛查时的社会阶层与癌症和非心血管、非癌症原因死亡率的相关性更强。结论：影响一生的社会经济因素会影响健康和过早死亡的风险。不同阶段影响的相对重要性因死因而异，仅使用生命某一阶段社会经济环境数据的研究不足以充分阐明社会经济因素对健康和死亡风险的贡献。
Objectives: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes.Design: Prospective observational study with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants' lives: from the social class of their father's job, the social class of their first job, and the social class of their job at the time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages.Setting: 27 workplaces in the west of Scotland.Participants: 5766 men aged 35-64 at the time of examination. Main outcome measures. Prevalence and level of risk factors for cardiovascular disease, morbidity, and mortality from broad causes of death.Results: From non-manual social class locations at all three life stages to manual at all stages there were strong positive trends for blood pressure, body mass index, current cigarette smoking, angina, and bronchitis. Inverse trends were seen for height, cholesterol concentration, lung function, and being an ex-smoker. 1580 men died during follow up. Age adjusted relative death rates in comparison with the men of non-manual social class locations at all three stages of life were 1.29 (95% confidence interval 1.08 to 1.56) in men of two non-manual and one manual social class; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all three stages. Mortality from cardiovascular disease showed a similar graded association with cumulative social class. Mortality from cancer was mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease, Fathers having a non-manual occupation was strongly associated with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants' social class at the time of screening was more strongly associated than the other social class indicators with mortality from cancer and from non-cardiovascular, non-cancer causes.Conclusions: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death, Studies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health and mortality risk.