Using genetic data to better understand effects of socioeconomic and cognitive factors on health and health inequalities

背景：许多研究表明，存在与一系列健康结果相关的长期健康不平等，健康状况通常随着社会经济地位（SEP）的提高而改善。许多国家和跨国政府组织已将减少卫生方面的社会经济不平等作为卫生政策的明确目标。为了减少这种不平等现象并为减少行动和政策提供信息，需要有关于社会经济因素与多种健康结果之间关联的有力证据。然而，由于现有的观察性研究存在反向因果关系和未观察到的混杂偏倚，因此很难从经验上进行因果推断。除了社会经济因素，现有的研究也表明认知因素与健康之间存在关联。研究发现，儿童时期较高的认知测试分数与随后较好的健康状况有关，并提出了几种可能的机制来解释这种联系。此外，认知和SEP在整个生命过程中密切相关。然而，认知对健康的独立影响以及认知和SEP与随后健康结果的因果关系方向尚不清楚，因为大多数现有研究都侧重于分别研究SEP和认知的影响。目的和方法：这个项目的主要目的是调查社会经济和认知因素对英国健康和健康不平等的影响，使用新的描述性和因果估计分析。该项目将使用来自英国出生队列的数据（1946年；1958年；1970年；2001年队列），这允许跨队列比较和随时间的关联模式进行分析。为了加强建立因果关系的证据，将使用回归分析和孟德尔随机化（MR）。通过使用MR，将调查社会经济和认知因素对健康结果的遗传归因影响，并可以提供更有力的因果推理证据。本研究将采用多结果方法，同时研究SEP和认知对多种健康结果的影响，并理清它们对不同健康结果的潜在不同影响。以前关于教育类型和随后的保健的轮转工作将作为这个完整项目的一个章节纳入。

Background:Much research has suggested that longstanding health inequalities relating to a range of health outcomes exist, with health typically improving as socioeconomic position (SEP) rises. Many countries and transnational governmental organisations have made the reduction of socioeconomic inequalities in health an explicit aim of health policies. To reduce such inequalities and inform reduction initiatives and policies, robust evidence on the associations between socioeconomic factors and multiple health outcomes is needed. However, causal inferences are difficult to make empirically, with existing observational studies subjected to reverse causality and unobserved confounding bias. Apart from socioeconomic factors, existing studies have also suggested an association between cognitive factors and health. Higher cognitive test scores in childhood were found to be associated with better subsequent health, and several potential mechanisms have been suggested to explain this association. Moreover, cognition and SEP are strongly associated across the life course. However, the independent effects of cognition on health and the causal direction of cognition and SEP with subsequent health outcomes remains unclear, as most existing studies have focused on investigating the effects of SEP and cognition separately. Aims and methods:The main aim of this project is to investigate the effects of socioeconomic and cognitive factors on health and health inequalities in the UK, using new descriptive and causal estimation analyses. The project will use data from the UK birth cohorts (1946; 1958; 1970; 2001 cohort), which allows cross-cohort comparison and patterns of association over time to be analysed. To strengthen evidence on establishing causal relationships, both regression analyses and Mendelian randomisation (MR) will be used. By using MR, the genetically-attributable effects of socioeconomic and cognitive factors on health outcomes will be investigated and stronger evidence on causal inference can be made. A multi-outcome approach will be used, which can investigate the effects of SEP and cognition on multiple health outcomes simultaneously and disentangle the potentially different effects on different health outcomes. Previous rotation work on type of education and subsequent health will be incorporated as a chapter of this full project.