Association of socioeconomic position with health behaviors and mortality.
Association of socioeconomic position with health behaviors and mortality.
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DOI：
10.1001/jama.2010.297
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发表时间：
2010-03-24
影响因子：
120.7
通讯作者：
Singh-Manoux, Archana
中科院分区：
文献类型：
--
作者：
Stringhini, Silvia;Sabia, Severine;Shipley, Martin;Brunner, Eric;Nabi, Hermann;Kivimaki, Mika;Singh-Manoux, Archana
以前的研究可能低估了健康行为在死亡率方面对社会不平等的贡献，因为健康行为只在研究的基线进行评估。研究健康行为在社会经济地位和死亡率之间的关系中的作用，并比较仅在一个时间点评估它们的贡献是否与通过随访纵向评估的贡献不同。全因死亡和特定原因死亡。参与者来自英国白厅II纵向队列研究，该研究成立于1985年，对10,308名年龄在35岁至55岁之间的伦敦公务员进行了调查。对9,590名男性和女性的死亡率进行了分析，直到2009年。社会经济地位是根据基线上的公务员雇用级别(高、中、低)得出的。在随访中，吸烟、饮酒、饮食和体力活动被评估了四次。654名参与者在随访期间死亡。在调整了性别和出生年份的分析中，处于较低社会经济地位的人死于各种原因的风险是处于较高地位的人的1.60倍(每1000人年的比率差异为1.94)。当基线评估的健康行为被输入到模型中时，这种关联减弱了42%(95%可信区间，21%-94%)，当它们被作为时间依赖协变量输入时，这种关联减弱了72%(95%可信区间，42%-154%)。心血管病死率分别为29%(95%CI，11%~54%)和45%(95%CI，24%~79%)，非癌症非心血管病死率分别为61%(95%CI，16%~425%)和94%(95%CI，35%~595%)。仅对健康行为进行基线评估和重复评估之间的差异主要是由于饮食(全因死亡率从7%增加到17%)、体力活动(全因死亡率从5%增加到21%)和饮酒(全因死亡率从3%增加到12%)的解释力增加。吸烟是这些分析中最强的中介因素，当使用基线或重复评估时，吸烟的作用没有改变(全因死亡率从32%到35%)。在伦敦的公务员群体中，社会经济地位和死亡率之间存在关联，这在很大程度上是通过对健康行为的调整来解释的，特别是当这些行为被反复评估时。
Previous studies may have underestimated the contribution of health behaviors to social inequalities in mortality because health behaviors were assessed only at the baseline of the study. To examine the role of health behaviors in the association between socioeconomic position and mortality and compare whether their contribution differs when assessed at only one point in time to that assessed longitudinally through the follow-up. All-cause and cause-specific mortality. Participants are drawn from the British Whitehall II longitudinal cohort study, established in 1985 on 10,308 London based civil servants, aged 35–55 years. Analyses are based on 9,590 men and women followed for mortality until 2009. Socioeconomic position was derived from civil service employment grade (high, intermediate and low) at baseline. Smoking, alcohol consumption, diet and physical activity were assessed four times over the follow-up. 654 participants died during the follow-up. In analysis adjusted for sex and year of birth, those in the low socioeconomic position had 1.60 times higher risk of death from all causes than those in the high position (a rate difference of 1.94 per 1000 person-years). This association was attenuated by 42% (95% CI, 21%–94%) when health behaviors assessed at baseline were entered into the model and by 72% (95% CI, 42%–154%) when they were entered as time dependent covariates. The corresponding attenuations were 29% (95% CI, 11%–54%) and 45% (95% CI, 24%–79%) for cardiovascular mortality and 61% (95% CI, 16%–425%) and 94% (95% CI, 35%–595%) for non-cancer non-cardiovascular mortality. The difference between the baseline only and repeated assessments of health behaviors was mostly due to an increased explanatory power of diet (from 7% to 17% for all-cause mortality), physical activity (from 5% to 21% for all-cause mortality) and alcohol consumption (from 3% to 12% for all-cause mortality). The role of smoking, the strongest mediator in these analyses, did not change when using baseline or repeat assessments (from 32% to 35% for all-cause mortality). In a civil service population in London, there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly.
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影响因子：
5.4
作者：
Hemström, Ö
通讯作者：
Hemström, Ö
影响因子：
15.8
作者：
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作者：
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通讯作者：
Colditz, Graham A.
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作者：
Britton, A;Singh-Manoux, A;Marmot, M
通讯作者：
Marmot, M