Brunner E, Shipley M J, Blane D, Smith G D, Marmot M G
Department of Epidemiology and Public Health, University College, London.
J Epidemiol Community Health. 1999 Dec;53(12):757-64. doi: 10.1136/jech.53.12.757.
To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances.
Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages.
The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88.
4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances.
Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent.
Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.
比较儿童期和成年期社会经济地位与成年期测量的心血管危险因素之间的关联。评估在调整儿童期情况后成年期社会经济地位的影响。
横断面调查，使用不平等相对指数方法比较不同生命阶段的社会经济差异。
白厅II纵向研究，研究对象为1985 - 1988年基线时受雇于伦敦公务员办公室的男性和女性。
4774名男性和2206名女性，出生于1930 - 1953年期间，接受了关于早期社会经济情况的询问。
成年职业地位（就业等级）与当前吸烟、休闲时间缺乏身体活动、腰高比以及代谢危险因素高密度脂蛋白胆固醇、甘油三酯、负荷后血糖和纤维蛋白原呈负相关（高地位 - 低风险）。除女性吸烟外，这些变量与儿童期社会经济地位（父亲的注册总署社会阶层）的关联较弱或不存在。儿童期社会地位与男女的成年体重相关，与女性的当前吸烟、腰高比、高密度脂蛋白胆固醇和纤维蛋白原相关。身高作为健康资本或体质的一个指标，与父亲的社会阶层联系较弱，与自身就业等级联系较强。男性儿童期劣势（父亲阶层低）与低地位文职职业相结合，尤其与成年后较高的体重指数相关（交互检验p < 0.001）。同时使用父亲的阶层和自身教育水平对早期社会经济地位进行调整，并没有削弱成年期社会经济地位的影响，但女性吸烟情况除外，此时等级效应降低了59%。
成年期的心血管危险因素总体上与成年期社会经济地位的相关性比与儿童期社会经济地位的相关性更强。在女性而非男性中，父亲的阶层与成年吸烟习惯之间存在强烈但无法解释的联系。肥胖程度在男女中均与儿童期和成年期社会地位相关。这些发现表明，健康资本和心血管风险的社会模式积累始于儿童期，并根据社会经济地位在成年期持续存在。
