Bobak M, Hertzman C, Skodova Z, Marmot M
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK.
Int J Epidemiol. 1999 Feb;28(1):46-52. doi: 10.1093/ije/28.1.46.
In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and magnitude of the socioeconomic gradient in cardiovascular risk factors in a former communist country. As the relationship between material conditions and education has been much weaker than in the west, we have also attempted to separate their effects.
A cross-sectional survey examined a random sample of men and women resident in six Czech districts participating in the MONICA study in 1992. Participants completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided a blood sample. Two indicators of SES were used: education and material conditions, the indicator constructed from car ownership and crowding. Linear regression was employed to analyse the relation between SES and total and high-density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height. Logistic regression was used to assess the association between SES and smoking and hypertension.
A total of 1141 men and 1212 women (overall response rate 75%) participated in the study. After controlling for age, all risk factors were associated with education, except HDL cholesterol in women and BMI in men; only smoking in both sexes and WHR in women and height in men were significantly related to material conditions. In mutually adjusted analyses, educational gradients persisted but associations with material conditions disappeared or became substantially weaker. The magnitude of the educational differences was similar to those found in western countries.
Socioeconomic differences in cardiovascular risk factors in Czech Republic in 1992 had the same direction and similar magnitude as in Western Europe, and were strongly related to education rather than material conditions. Materialist explanations for the social differences seem unlikely in this population.
在西方国家，社会经济地位较低的群体中，心血管疾病及大多数风险因素的患病率较高。前共产主义社会中的社会梯度情况则鲜为人知。由于在西方国家，社会经济地位（SES）的不同指标相互关联，因此这一梯度可通过多种不同的SES衡量指标得以发现。我们分析了一个前共产主义国家中心血管疾病风险因素方面社会经济梯度的存在情况及程度。鉴于物质条件与教育之间的关系比西方弱得多，我们还试图区分它们的影响。
一项横断面调查对1992年参与莫尼卡（MONICA）研究的捷克六个地区的男性和女性居民进行了随机抽样。参与者完成了一份问卷，接受了人体测量和血压测量，并提供了血样。使用了两个SES指标：教育程度和物质条件，物质条件指标由汽车拥有情况和居住拥挤程度构建而成。采用线性回归分析SES与总胆固醇、高密度脂蛋白（HDL）胆固醇、体重指数（BMI）、腰臀比（WHR）和身高之间的关系。采用逻辑回归评估SES与吸烟和高血压之间的关联。
共有1141名男性和1212名女性（总体应答率75%）参与了研究。在控制年龄后，除女性的HDL胆固醇和男性的BMI外，所有风险因素均与教育程度相关；仅男女吸烟情况以及女性的WHR和男性的身高与物质条件显著相关。在相互调整分析中，教育梯度依然存在，但与物质条件的关联消失或明显减弱。教育差异的程度与西方国家相似。
1992年捷克共和国心血管疾病风险因素方面的社会经济差异与西欧的方向相同且程度相似，并且与教育程度密切相关，而非物质条件。对于该人群中社会差异的唯物主义解释似乎不太可能成立。
