Ali Sadiq M, Merlo Juan, Rosvall Maria, Lithman Thor, Lindström Martin
Department of Health Sciences, Lund University, Sweden.
Soc Sci Med. 2006 Oct;63(8):2204-17. doi: 10.1016/j.socscimed.2006.04.007. Epub 2006 Jun 23.
This longitudinal study investigates the impact of social participation, trust and the combinations of social participation and trust on the incidence of first time acute myocardial infarction (AMI) in the population of Scania, southern Sweden. It is based on the cross-sectional 2000 public-health survey in Scania with a 59% participation rate and 13,604 participants, and prospective morbidity/mortality data collected for three years (January 2000-December 2002). The study cohort was followed prospectively to examine first ever AMI. Hazard rate ratios (HRR) for first time AMI in the social participation, trust and social participation/trust combinations were calculated in a Cox regression model with adjustments for age, sex, education, economic stress, daily smoking, leisure time physical activity, body mass index (BMI), and self-reported health. The prevalence of low social participation was 32.8% among men and 31.5% among women. The prevalence of low trust was 40.0% among men and 44.2% among women. The three-year first time AMI rate was significantly higher among people with higher age, low education, daily smoking, poor self-reported health (among men), low social participation, and the combinations of low social participation/high trust and low social participation/low trust. The results show that low social participation but not trust was significantly associated with first time AMI after adjustment for age and sex. The positive association between low social participation and myocardial infarction remained significant after further adjustments for education, economic stress, daily smoking, physical activity and BMI, and became not significant only after additional adjustment for self-reported health, HRR 1.3 (0.9-2.0). High trust in combination with low social participation as well as low social capital (low trust/low social participation) were significantly associated with AMI, but after multiple adjustments only the low social participation/high trust category remained significant, HRR 1.6 (1.0-2.6).
这项纵向研究调查了瑞典南部斯科讷地区人群中社会参与、信任以及社会参与与信任的组合对首次急性心肌梗死（AMI）发病率的影响。该研究基于2000年斯科讷地区的横断面公共卫生调查，参与率为59%，共有13604名参与者，并收集了为期三年（2000年1月至2002年12月）的前瞻性发病/死亡数据。对研究队列进行前瞻性跟踪以检查首次发生的AMI。在Cox回归模型中计算社会参与、信任以及社会参与/信任组合中首次AMI的风险率比（HRR），并对年龄、性别、教育程度、经济压力、每日吸烟情况、休闲时间体育活动、体重指数（BMI）和自我报告的健康状况进行了调整。低社会参与的患病率在男性中为32.8%，在女性中为31.5%。低信任的患病率在男性中为40.0%，在女性中为44.2%。在年龄较大、教育程度低、每日吸烟、自我报告健康状况差（男性中）、社会参与度低以及社会参与度低/信任度高和社会参与度低/信任度低的组合人群中，三年首次AMI发生率显著更高。结果表明，在对年龄和性别进行调整后，低社会参与而非信任与首次AMI显著相关。在进一步对教育程度、经济压力、每日吸烟、体育活动和BMI进行调整后，低社会参与与心肌梗死之间的正相关仍然显著，仅在对自我报告的健康状况进行额外调整后才变得不显著，HRR为1.3（0.9 - 2.0）。高信任与低社会参与以及低社会资本（低信任/低社会参与）与AMI显著相关，但在多次调整后，只有低社会参与/高信任类别仍然显著，HRR为1.6（1.0 - 2.6）。
