Kim Soowon, Symons Michael, Popkin Barry M
Department of Nutrition, University of North Carolina, Chapel Hill, NC 27516, USA.
Am J Epidemiol. 2004 Jan 15;159(2):184-91. doi: 10.1093/aje/kwh006.
Health disparity by socioeconomic status has recently become an important public health concern. Socioeconomic status may affect health status through several pathways including lifestyle choices. The authors tested the link between socioeconomic status and lifestyle in China (in 1993) and in the United States (in 1994-1996), countries with high contrasts in development, to understand health discrepancy issues cross-nationally. Healthfulness of lifestyle was measured using the Lifestyle Index, a summary score that integrates four key lifestyle factors: diet, physical activity, smoking, and alcohol consumption. Income and education were used as indicators of socioeconomic status. In China, as socioeconomic status improved, lifestyle was less healthy (relative odds for the highest socioeconomic status group = 0.19, 95% confidence interval: 0.10, 0.35). Conversely, in the United States, higher socioeconomic status was related to a healthier lifestyle (relative odds for the highest socioeconomic status group = 3.81, 95% confidence interval: 2.94, 4.94). The contrasting relation between socioeconomic status and lifestyle depicts different phases of the lifestyle transition (changes in lifestyles accompanying economic development). The differences may in part explain why nutrition-related noncommunicable diseases are more prevalent in the developing world among people with a high socioeconomic status, whereas often the opposite is found in developed societies. Public health programs may benefit by advising each socioeconomic status group separately, while considering the country's level of development.
社会经济地位导致的健康差异最近已成为一个重要的公共卫生问题。社会经济地位可能通过包括生活方式选择在内的多种途径影响健康状况。作者对中国（1993年）和美国（1994 - 1996年）这两个发展水平差异很大的国家的社会经济地位与生活方式之间的联系进行了测试，以了解跨国的健康差异问题。生活方式的健康程度是使用生活方式指数来衡量的，这是一个综合了四个关键生活方式因素的总分：饮食、体育活动、吸烟和饮酒。收入和教育被用作社会经济地位的指标。在中国，随着社会经济地位的提高，生活方式却变得不那么健康（社会经济地位最高组的相对比值 = 0.19，95%置信区间：0.10，0.35）。相反，在美国，较高的社会经济地位与更健康的生活方式相关（社会经济地位最高组的相对比值 = 3.81，95%置信区间：2.94，4.94）。社会经济地位与生活方式之间的这种对比关系描绘了生活方式转变的不同阶段（伴随经济发展的生活方式变化）。这些差异可能部分解释了为什么在发展中国家，与营养相关的非传染性疾病在社会经济地位较高的人群中更为普遍，而在发达社会中情况往往相反。公共卫生项目在分别为每个社会经济地位群体提供建议时，同时考虑国家的发展水平，可能会从中受益。
