儿童社会经济劣势经历与成人健康之间的关联：一项生命历程研究。
Association between children's experience of socioeconomic disadvantage and adult health: a life-course study.
作者信息
Poulton Richie, Caspi Avshalom, Milne Barry J, Thomson W Murray, Taylor Alan, Sears Malcolm R, Moffitt Terrie E
机构信息
Dunedin Multidisciplinary Health and Development Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
出版信息
Lancet. 2002 Nov 23;360(9346):1640-5. doi: 10.1016/S0140-6736(02)11602-3.
BACKGROUND
Research into social inequalities in health has tended to focus on low socioeconomic status in adulthood. We aimed to test the hypothesis that children's experience of socioeconomic disadvantage is associated with a wide range of health risk factors and outcomes in adult life.
METHODS
We studied an unselected cohort of 1000 children (born in New Zealand during 1972-73) who had been assessed at birth and ages 3, 5, 7, 9, 11, 13, and 15 years. At age 26 years, we assessed these individuals for health outcomes including body-mass index, waist:hip ratio, blood pressure, cardiorespiratory fitness, dental caries, plaque scores, gingival bleeding, periodontal disease, major depression, and tobacco and alcohol dependence, and tested for associations between these variables and childhood and adult socioeconomic status.
FINDINGS
Compared with those from high socioeconomic status backgrounds, children who grew up in low socioeconomic status families had poorer cardiovascular health. Significant differences were also found on all dental health measures, with a threefold increase in adult periodontal disease (31.1% vs 11.9%) and caries level (32.2% vs 9.9%) in low versus high childhood socioeconomic status groups. Substance abuse resulting in clinical dependence was related in a similar way to childhood socioeconomic status (eg, 21.5% vs 12.1% for adult alcohol dependence). The longitudinal associations could not be attributed to life-course continuity of low socioeconomic status, and upward mobility did not mitigate or reverse the adverse effects of low childhood socioeconomic status on adult health.
INTERPRETATION
Protecting children against the effects of socioeconomic adversity could reduce the burden of disease experienced by adults. These findings provide strong impetus for policy makers, practitioners, and researchers to direct energy and resources towards childhood as a way of improving population health.
背景
对健康方面社会不平等的研究往往聚焦于成年期的低社会经济地位。我们旨在检验这一假设，即儿童时期经历的社会经济劣势与成年后的一系列健康风险因素及结果相关。
方法
我们研究了一组未经挑选的1000名儿童（1972 - 1973年出生于新西兰），他们在出生时以及3岁、5岁、7岁、9岁、11岁、13岁和15岁时接受了评估。在26岁时，我们对这些个体的健康结果进行了评估，包括体重指数、腰臀比、血压、心肺适能、龋齿、牙菌斑评分、牙龈出血、牙周疾病、重度抑郁症以及烟草和酒精依赖，并测试了这些变量与儿童期及成年期社会经济地位之间的关联。
研究结果
与来自高社会经济地位背景的儿童相比，在低社会经济地位家庭中成长的儿童心血管健康较差。在所有牙齿健康指标上也发现了显著差异，低儿童期社会经济地位组与高儿童期社会经济地位组相比，成年期牙周疾病（31.1%对11.9%）和龋齿水平（32.2%对9.9%）增加了两倍。导致临床依赖的药物滥用与儿童期社会经济地位的关系类似（例如，成年酒精依赖为21.5%对12.1%）。纵向关联不能归因于低社会经济地位的生命历程连续性，社会经济地位向上流动也未能减轻或扭转儿童期低社会经济地位对成年健康的不利影响。
解读
保护儿童免受社会经济逆境的影响可以减轻成年人所经历的疾病负担。这些发现为政策制定者、从业者和研究人员提供了强大动力，促使他们将精力和资源投入到儿童期，以此作为改善人群健康的一种方式。
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