Kuper Hannah, Adami Hans-Olov, Theorell Töres, Weiderpass Elisabete
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Epidemiol. 2006 Aug 15;164(4):349-57. doi: 10.1093/aje/kwj212. Epub 2006 Jun 20.
A social gradient in coronary heart disease (CHD) has been documented in a variety of settings, predominantly among men. This study aimed to establish whether a social gradient in CHD existed in a group of Swedish women and whether it could be explained by established coronary risk factors or psychosocial factors. The Women's Lifestyle and Health Cohort Study includes 49,259 women from Sweden aged 30-50 years at baseline (1991-1992), when an extensive questionnaire was completed. There was complete follow-up through linkages to national registries until the end of 2002, during which time 210 cases of incident fatal CHD or nonfatal myocardial infarction occurred. Risk of CHD was significantly inversely related to years of education, the socioeconomic status proxy (hazard ratio comparing the lowest with the highest education group = 3.3, 95% confidence interval: 2.2, 4.7). This association was reduced after adjustment for established coronary risk factors (smoking, body mass index, alcohol consumption, diabetes, hypertension, exercise; hazard ratio = 1.9, 95% confidence interval: 1.3, 2.8). Job strain and social support were weakly related to CHD and did not explain the gradient by years of education. Self-rated health was strongly related to CHD, mediated by established coronary risk factors. Results show a strong gradient in CHD by years of education explained by established coronary risk factors but not by job strain or social support.
冠心病（CHD）的社会梯度差异已在多种环境中得到证实，主要存在于男性群体中。本研究旨在确定瑞典女性群体中是否存在冠心病的社会梯度差异，以及这种差异是否可以用既定的冠心病风险因素或社会心理因素来解释。女性生活方式与健康队列研究纳入了49259名来自瑞典的女性，她们在基线时（1991 - 1992年）年龄为30 - 50岁，当时完成了一份详尽的调查问卷。通过与国家登记处的关联实现了完整随访，直至2002年底，在此期间发生了210例致死性冠心病或非致死性心肌梗死事件。冠心病风险与受教育年限显著负相关，社会经济地位指标（最低与最高教育组的风险比 = 3.3，95%置信区间：2.2，4.7）。在对既定的冠心病风险因素（吸烟、体重指数、饮酒、糖尿病、高血压、运动）进行调整后，这种关联有所减弱（风险比 = 1.9，95%置信区间：1.3，2.8）。工作压力和社会支持与冠心病的关联较弱，且无法解释受教育年限导致的梯度差异。自我评估健康状况与冠心病密切相关，由既定的冠心病风险因素介导。结果表明，受教育年限导致的冠心病梯度差异可由既定的冠心病风险因素解释，但不能由工作压力或社会支持解释。
