Dowd Jennifer B, Goldman Noreen
Center for Social Epidemiology and Population Health, University of Michigan,1214 South University Avenue, 2nd Floor, Ann Arbor, MI 48104-2548, USA.
J Epidemiol Community Health. 2006 Jul;60(7):633-9. doi: 10.1136/jech.2005.040816.
To test the relation between socioeconomic status (SES) and biomarkers of chronic stress, including basal cortisol, and to test whether these biomarkers account for the relation between SES and health outcomes.
Cross sectional study using data from the 2000 social and environmental biomarkers of aging study (SEBAS).
Taiwan.
Nationally representative sample of 972 men and women aged 54 and older.
Highest risk quartiles for 13 biomarkers representing functioning of the neuroendocrine system, immune/inflammatory systems, and the cardiovascular system: cortisol, adrenaline (epinephrine), noradrenaline (norepinephrine), serum dihydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor 1 (IGF1), interleukin 6 (IL6), albumin, systolic blood pressure, diastolic blood pressure, waist-hip ratio, total cholesterol-HDL ratio, HDL cholesterol, and glycosylated haemoglobin; self reported health status (1-5) and self reported mobility difficulties (0-6).
Lower SES men have greater odds of falling into the highest risk quartile for only 2 of 13 biomarkers, and show a lower risk for 3 of the 13 biomarkers, with no association between SES and cortisol. Lower SES women have a higher risk for many of the cardiovascular risk factors, but a lower risk for increased basal readings of adrenaline, noradrenaline, and cortisol. Inclusion of all 13 biological markers does not explain the relation between SES and health outcomes in the sample.
These data do not support the hypothesis that chronic stress, via sustained activation of stress related autonomic and neuroendocrine responses, is an important mediator in the relation between SES and health outcomes. Most notably, lower SES is not associated with higher basal levels of cortisol in either men or women. These results place an increased burden of proof on researchers who assert that psychosocial stress is an important pathway linking SES and health.
检验社会经济地位（SES）与慢性应激生物标志物（包括基础皮质醇）之间的关系，并检验这些生物标志物是否能够解释SES与健康结果之间的关系。
采用2000年衰老社会与环境生物标志物研究（SEBAS）的数据进行横断面研究。
台湾。
972名年龄在54岁及以上的具有全国代表性的男性和女性样本。
代表神经内分泌系统、免疫/炎症系统和心血管系统功能的13种生物标志物的最高风险四分位数：皮质醇、肾上腺素、去甲肾上腺素、血清硫酸脱氢表雄酮（DHEA-S）、胰岛素样生长因子1（IGF1）、白细胞介素6（IL6）、白蛋白、收缩压、舒张压、腰臀比、总胆固醇与高密度脂蛋白比值、高密度脂蛋白胆固醇和糖化血红蛋白；自我报告的健康状况（1-5）和自我报告的行动困难（0-6）。
社会经济地位较低的男性仅在13种生物标志物中的2种处于最高风险四分位数的几率更高，而在13种生物标志物中的3种显示出较低风险，SES与皮质醇之间无关联。社会经济地位较低的女性患多种心血管危险因素的风险较高，但肾上腺素、去甲肾上腺素和皮质醇基础读数升高的风险较低。纳入所有13种生物标志物并不能解释样本中SES与健康结果之间的关系。
这些数据不支持以下假设，即慢性应激通过持续激活与应激相关的自主神经和神经内分泌反应，是SES与健康结果之间关系的重要介导因素。最值得注意的是，社会经济地位较低与男性或女性的基础皮质醇水平较高无关。这些结果给那些断言社会心理应激是连接SES与健康的重要途径的研究人员带来了更大的举证责任。
