Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of US adults
Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of US adults
复制标题
DOI：
10.1016/j.socscimed.2010.02.003
复制
发表时间：
2010-05-01
影响因子：
5.4
通讯作者：
Morenoff, Jeffrey
中科院分区：
文献类型：
--
作者：
Lantz, Paula M.;Golberstein, Ezra;Morenoff, Jeffrey
在美国，许多人口统计学、社会经济和行为风险因素可以预测死亡率。然而，很少有以人口为基础的纵向研究能够同时调查各种社会因素对死亡率的影响。我们调查了人口统计学特征、社会经济变量和主要健康风险因素与死亡率的关联程度，研究对象是1986年至2005年间3617名美国成年人的全国代表性样本，使用的数据来自美国人改变生活研究的四波。采用带时变协变量的Cox比例风险模型预测全因死亡率，并通过国家死亡指数和死亡证明复核进行验证。结果显示，当模型中包含收入和健康风险行为时，低教育程度与死亡率无关。在控制了主要的行为风险后，低收入与死亡率的关系仍然存在。与“正常”体重的人相比，超重和肥胖与死亡风险都没有显著关联。在55岁及以上的成年人中，在控制了其他健康风险行为和健康状况后，超重（危险率比= 0.83）和肥胖（危险率比= 0.68）的死亡风险实际上降低了。身体活动水平低是死亡的一个重要危险因素（危险率比= 1.58）。这项全国纵向研究的结果强调需要制定卫生政策和临床干预措施，重点关注健康的社会和行为决定因素，特别关注收入保障、预防/戒烟和身体活动。(C) 2010 Elsevier Ltd.版权所有。
Many demographic, socioeconomic, and behavioral risk factors predict mortality in the United States. However, very few population-based longitudinal studies are able to investigate simultaneously the impact of a variety of social factors on mortality. We investigated the degree to which demographic characteristics, socioeconomic variables and major health risk factors were associated with mortality in a nationally-representative sample of 3617 U.S. adults from 1986 to 2005, using data from the 4 waves of the Americans' Changing Lives study. Cox proportional hazard models with time-varying covariates were employed to predict all-cause mortality verified through the National Death Index and death certificate review. The results revealed that low educational attainment was not associated with mortality when income and health risk behaviors were included in the model. The association of low income with mortality remained after controlling for major behavioral risks. Compared to those in the "normal" weight category, neither overweight nor obesity was significantly associated with the risk of mortality. Among adults age 55 and older at baseline, the risk of mortality was actually reduced for those were overweight (hazard rate ratio = 0.83) and those who were obese (hazard rate ratio = 0.68), controlling for other health risk behaviors and health status. Having a low level of physical activity was a significant risk factor for mortality (hazard rate ratio = 1.58). The results from this national longitudinal study underscore the need for health policies and clinical interventions focusing on the social and behavioral determinants of health, with a particular focus on income security, smoking prevention/cessation, and physical activity. (C) 2010 Elsevier Ltd. All rights reserved.