Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50-87 years: results from a Swedish birth cohort
Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50-87 years: results from a Swedish birth cohort
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DOI：
10.1007/s10654-013-9777-z
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发表时间：
2013-02-01
影响因子：
13.6
通讯作者：
Koupil, Ilona
中科院分区：
文献类型：
--
作者：
Mishra, Gita Devi;Chiesa, Flaminia;Koupil, Ilona
儿童和成人的社会经济地位（SEP）预测成人死亡率，但鲜为人知的是，在整个生命过程中的SEP的影响的变化。乌普萨拉出生队列研究（Uppsala Birth Cohort Study）是1915-1929年出生于瑞典乌普萨拉的一项代表性出生队列研究。对于1980年存活的5，138名男性和5，069名女性而言，SEP在出生时、成年期（31-45岁）和晚年（51-65岁）都有。死亡率（全因和循环系统疾病）的随访时间为1980年至2002年。为了检验哪种生命过程模型最能描述SEP与死亡率之间的关联，我们比较了一系列嵌套考克斯比例风险回归模型（代表临界期、累积期或敏感期模型）与完全饱和模型的拟合。对于两种性别的全因死亡率，敏感期模型最好地描述了SEP在整个生命过程中的影响，在成年后的生活中影响更大（男性：TSEP的风险比（95% CI）：0.89（0.81-0.97），成年期0.90（0.81-0.98），晚年0.74（0.67-0.82）;女性：0.87（0.78-0.98），0.95（0.86-1.06），0.73（0.64-0.83））。SEP对男性循环系统疾病死亡率的影响具有累积性（HR：0.84（0.80-0.87）/单位时间）。对于女性的循环系统疾病死亡率，由于成年后的SEP选择了敏感期模型（HR：0.64（0.52-0.80））。这些发现表明，减少整个生命过程中的不平等可能会降低全因和循环系统疾病的死亡率。
Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915-1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31-45); and in later life (age 51-65). Follow-up for mortality (all-cause, and circulatory disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95 % CI) for advantaged SEP: 0.89 (0.81-0.97) at birth, 0.90 (0.81-0.98) in adulthood, 0.74 (0.67-0.82) in later life; females: 0.87 (0.78-0.98), 0.95 (0.86-1.06), 0.73 (0.64-0.83)). The effect of SEP on circulatory diseases mortality in males was cumulative (HR: 0.84 (0.80-0.87) per unit time in advantaged SEP). For circulatory disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52-0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and circulatory disease mortality.