Yarnell J, Yu S, McCrum E, Arveiler D, Hass B, Dallongeville J, Montaye M, Amouyel P, Ferrières J, Ruidavets J-B, Evans A, Bingham A, Ducimetière P
Belfast-MONICA, Department of Epidemiology and Public Health, Queen's University Belfast, Belfast, UK.
Int J Epidemiol. 2005 Apr;34(2):268-75. doi: 10.1093/ije/dyh267. Epub 2004 Aug 19.
Socioeconomic differentials have been described in the risk of coronary heart disease (CHD) but the extent to which these differentials are explained by lifestyle factors has been examined to a lesser degree. We have examined the contribution of socio-economic factors to risk of CHD in a large cohort study in France and Northern Ireland.
In all, 10 593 men aged 50-59 years were examined between 1991 and 1994 in centres in Northern Ireland, Lille, Strasbourg, and Toulouse. Details were obtained for a number of socio-economic indicators from the men at the baseline examination. Men were also screened for evidence of CHD and followed annually by questionnaire for incident cases of coronary disease. Coronary events (coronary deaths, myocardial infarction, and angina) were documented by clinical records and were reviewed by an independent medical committee.
In all, 842 men (8%) showed some evidence of CHD at screening examination and these men were more likely to be living in poorer material circumstances, be unemployed, or have had less full-time education than men without CHD at screening in both France and Northern Ireland. These relationships persisted following adjustment for all known risk factors for CHD. Among men who were initially free of CHD there were clear socio-economic differentials (years of full-time education, unemployment, and educational level) in the distribution of several risk factors for CHD, notably smoking habit (which differs in France and Northern Ireland), systolic blood pressure, body mass index, and fibrinogen. Total cholesterol in contrast showed no socio-economic differential whilst those with a shorter period of full-time education and the unemployed tended to be high consumers of alcohol. In this cohort of men free of CHD at baseline few socio-economic indicators showed relationships with risk of CHD by 5 years of follow-up. Only years in full education, educational level, and unemployment status when adjusted only for age and country showed significant relationships with CHD risk, but these became non-significant following adjustment for major CHD risk factors.
Socio-economic differentials in long-term risk of CHD are apparent in both cohorts of men from France and Northern Ireland, particularly in men with evidence of CHD at baseline. Among men free of CHD at baseline, although there is strong evidence of socio-economic differentials in cardiovascular risk factors these do not contribute independently to risk of CHD at 5 years of follow-up in this large cohort of men from France and Northern Ireland.
冠心病（CHD）风险存在社会经济差异，但生活方式因素对这些差异的解释程度研究较少。我们在法国和北爱尔兰的一项大型队列研究中，考察了社会经济因素对冠心病风险的影响。
1991年至1994年期间，在北爱尔兰、里尔、斯特拉斯堡和图卢兹的研究中心，对10593名年龄在50 - 59岁的男性进行了检查。在基线检查时，收集了这些男性的一些社会经济指标详情。还对男性进行了冠心病证据筛查，并通过问卷调查对冠心病新发病例进行年度随访。冠心病事件（冠心病死亡、心肌梗死和心绞痛）通过临床记录进行记录，并由一个独立的医学委员会进行审查。
在筛查检查中，共有842名男性（8%）显示出一些冠心病证据，在法国和北爱尔兰，这些男性比筛查时无冠心病的男性更可能生活在物质条件较差的环境中、失业或接受的全日制教育较少。在对所有已知的冠心病风险因素进行调整后，这些关系依然存在。在最初无冠心病的男性中，冠心病的几个风险因素分布存在明显的社会经济差异（全日制教育年限、失业情况和教育水平），特别是吸烟习惯（在法国和北爱尔兰有所不同）、收缩压、体重指数和纤维蛋白原。相比之下，总胆固醇没有社会经济差异，而全日制教育年限较短和失业的男性往往是高酒精消费者。在这个基线时无冠心病的男性队列中，很少有社会经济指标显示与5年随访期内的冠心病风险有关。仅在调整年龄和国家后，全日制教育年限、教育水平和失业状况与冠心病风险存在显著关系，但在对主要冠心病风险因素进行调整后，这些关系变得不显著。
法国和北爱尔兰的男性队列中，冠心病长期风险的社会经济差异明显，特别是在基线时有冠心病证据的男性中。在基线时无冠心病的男性中，尽管心血管风险因素存在明显的社会经济差异，但在这个来自法国和北爱尔兰的大型男性队列中，这些因素在5年随访期内对冠心病风险并无独立影响。
