Beebe-Dimmer Jennifer, Lynch John W, Turrell Gavin, Lustgarten Stephanie, Raghunathan Trivellore, Kaplan George A
Department of Epidemiology, University of Michigan, Ann Arbor 48109-2029, USA.
Am J Epidemiol. 2004 Mar 1;159(5):481-90. doi: 10.1093/aje/kwh057.
Links between low socioeconomic position and poor health are well established. Most previous research, however, has focused on middle-aged males and has relied on limited socioeconomic data, usually measured at one point over the life course. This paper examines all-cause, cardiovascular, and noncardiovascular mortality in women in relation to socioeconomic position at different stages of the life course. Information was collected in 1965, 1974, 1983, and 1994 and included recalled father's occupation and education as a measure of childhood socioeconomic position and the respondent's household income, education and occupation, and spouse's occupation from a sample of 3,087 women participating in the Alameda County Study. Cox regression models were used to estimate hazard ratios for risk of death. Lower childhood socioeconomic position was associated with an increased mortality due to cardiovascular disease (hazard ratio (HR) = 1.29, 95% confidence interval (CI): 1.09, 1.54) but was unrelated to death due to other causes (HR = 0.97, 95% CI: 0.82, 1.15). Overall mortality was higher among women reporting the lowest level of education (HR = 1.17, 95% CI: 0.99, 1.39), but education was most strongly related to noncardiovascular disease-related deaths (HR = 1.41, 95% CI: 1.10, 1.81). Low household income was also associated with higher mortality, for both cardiovascular disease-related (HR = 1.47, 95% CI: 1.14, 1.91) and noncardiovascular disease-related (HR = 1.30, 95% CI: 1.03, 1.63) deaths. Both early and later life indicators of socioeconomic position contribute to increased mortality risk among socioeconomically disadvantaged women, but these effects appear stronger for cardiovascular mortality.
社会经济地位低下与健康状况不佳之间的联系已得到充分证实。然而，以往的大多数研究都集中在中年男性身上，并且所依赖的社会经济数据有限，通常是在生命历程中的某一个时间点进行测量。本文研究了女性在生命历程不同阶段的全因死亡率、心血管疾病死亡率和非心血管疾病死亡率与社会经济地位的关系。研究人员于1965年、1974年、1983年和1994年收集了相关信息，这些信息包括回忆起的父亲职业和教育程度，以此作为童年社会经济地位的衡量指标，以及来自参与阿拉米达县研究的3087名女性样本中的受访者家庭收入、教育程度和职业，还有配偶的职业。采用Cox回归模型来估计死亡风险的风险比。童年社会经济地位较低与心血管疾病导致的死亡率增加相关（风险比（HR）= 1.29，95%置信区间（CI）：1.09，1.54），但与其他原因导致的死亡无关（HR = 0.97，95% CI：0.82，1.15）。报告教育程度最低的女性总体死亡率较高（HR = 1.17，95% CI：0.99，1.39），但教育程度与非心血管疾病相关死亡的关联最为密切（HR = 1.41，95% CI：1.10，1.81）。低家庭收入也与较高的死亡率相关，无论是心血管疾病相关死亡（HR = 1.47，95% CI：1.14，1.91）还是非心血管疾病相关死亡（HR = 1.30，95% CI：1.03，1.63）。社会经济地位的早期和后期指标都导致社会经济弱势女性的死亡风险增加，但这些影响在心血管疾病死亡率方面似乎更强。
