Stjärne Maria K, Ponce de Leon Antonio, Hallqvist Johan
CHESS-Centre for Health Equity Studies, StockholmUniversity/Karolinska Institute, SE 106-91 Stockholm, Sweden.
Int J Epidemiol. 2004 Aug;33(4):732-41. doi: 10.1093/ije/dyh087. Epub 2004 May 20.
Socioeconomic deprivation has been suggested as a contextual feature of importance for cardiovascular disease and mortality, whereas the effect of social fragmentation has largely been studied in relation to suicide. In this study we examine the contextual effects of social fragmentation and material deprivation on the incidence of myocardial infarction (MI).
A population-based case-control study (SHEEP). The study base included all Swedish citizens aged 45-70 living in the Stockholm metropolitan area. Cases (n = 1631) were all first events of MI during 1992-1994. Exposure information on individual risk factors was obtained from a questionnaire. Areas (n = 862) were classified according to the Townsend index, measuring material deprivation, and the Congdon index, measuring social fragmentation.
We found increased incidence of MI in both materially deprived and socially fragmented contexts that were not due to confounding from individual social risk factors being more prevalent among subjects in deprived settings. The adjusted relative risk of MI was 2.0 (95% CI: 1.3, 3.1) for women living in the top quartile of materially deprived areas. For men, the adjusted relative risk (RR) was 1.6 (95% CI: 1.2, 2.1). Women living in the top quartile of socially fragmented areas had an RR of MI of 1.6 (95% CI: 1.0, 2.5) after adjustment, while the corresponding figure for men was 1.4 (95% CI: 1.0, 1.8).
Our findings support the notion that the social context in which people live has an impact on the risk of coronary heart disease. We could not determine which of the contextual aspects under study made the most substantial contribution. Mutual adjustment of the two indices suggests that material deprivation is the dominating factor, especially for women. However, the indices were highly correlated (r = 0.87), and it cannot be ruled out that they partly measure the same underlying phenomenon.
社会经济剥夺被认为是心血管疾病和死亡率的一个重要背景特征，而社会分裂的影响主要是在自杀方面进行研究的。在本研究中，我们考察了社会分裂和物质剥夺对心肌梗死（MI）发病率的背景影响。
一项基于人群的病例对照研究（SHEEP）。研究对象包括所有居住在斯德哥尔摩大都市区的45至70岁瑞典公民。病例（n = 1631）为1992 - 1994年间首次发生的心肌梗死事件。通过问卷获取个体危险因素的暴露信息。区域（n = 862）根据测量物质剥夺的汤森指数和测量社会分裂的康登指数进行分类。
我们发现，在物质匮乏和社会分裂的环境中，心肌梗死的发病率均有所增加，这并非由于个体社会危险因素的混杂作用，因为这些因素在贫困环境中的受试者中更为普遍。生活在物质剥夺程度最高四分位数区域的女性，心肌梗死的调整后相对风险为2.0（95%可信区间：1.3，3.1）。对于男性，调整后相对风险（RR）为1.6（95%可信区间：1.2，2.1）。生活在社会分裂程度最高四分位数区域的女性，调整后心肌梗死的RR为1.6（95%可信区间：1.0，2.5），而男性的相应数字为1.4（95%可信区间：1.0，1.8）。
我们的研究结果支持这样一种观点，即人们生活的社会环境会对冠心病风险产生影响。我们无法确定所研究的背景因素中哪一个贡献最大。两个指数的相互调整表明，物质剥夺是主导因素，尤其是对女性而言。然而，这两个指数高度相关（r = 0.87），不能排除它们部分测量了相同的潜在现象。
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