Ben-Shlomo Y, Smith G D
Department of Epidemiology and Public Health, University College and Middlesex School of Medicine, UK.
Lancet. 1991 Mar 2;337(8740):530-4. doi: 10.1016/0140-6736(91)91307-g.
Previous ecological studies have suggested that early life factors are important causes of adult cardiovascular and respiratory disease, by showing geographic correlations between past infant mortality rates and present adult mortality rates. However, these studies inadequately take account of the fact that areas which were severely deprived earlier this century remain the most deprived today. Thus the ecological relation between infant and adult mortality rates could simply reflect persistence in the geographic distribution of poor socioeconomic circumstances. To explore this hypothesis further infant mortality rates for 1895-1908 for 43 counties in England and Wales were correlated with cause-specific adult mortality for 1969-73 in people aged 65-74 years, with and without adjustment for present-day social deprivation and social class. The strong simple correlations found between infant mortality in 1895-1908 and adult mortality from various causes in 1969-73 were generally much attenuated or abolished by controlling for indices of present-day socioeconomic circumstances. Our results suggest that previous studies give no strong support for any direct influence of factors acting in early life on adult coronary heart disease mortality risk. Studies which gather data about infancy, childhood, and the full course of adult life are required to clarify this issue.
以往的生态学研究表明，通过显示过去婴儿死亡率与当前成人死亡率之间的地理相关性，早期生活因素是成人心血管疾病和呼吸系统疾病的重要病因。然而，这些研究没有充分考虑到这样一个事实，即本世纪初严重贫困的地区如今仍然是最贫困的地区。因此，婴儿死亡率与成人死亡率之间的生态关系可能仅仅反映了社会经济状况不佳的地理分布的持续性。为了进一步探讨这一假设，对英格兰和威尔士43个郡1895 - 1908年的婴儿死亡率与1969 - 1973年65 - 74岁人群特定病因的成人死亡率进行了相关性分析，同时对当前社会剥夺和社会阶层进行了调整和未调整的分析。通过控制当前社会经济状况指标，1895 - 1908年婴儿死亡率与1969 - 1973年各种病因成人死亡率之间发现的强简单相关性通常会大大减弱或消除。我们的结果表明，以往的研究没有有力支持早期生活中起作用的因素对成人冠心病死亡风险有任何直接影响。需要收集有关婴儿期、儿童期和成人整个生命过程数据的研究来阐明这个问题。
