Strachan David P, Rudnicka Alicja R, Power Chris, Shepherd Peter, Fuller Elizabeth, Davis Adrian, Gibb Ian, Kumari Meena, Rumley Ann, Macfarlane Gary J, Rahi Jugnoo, Rodgers Bryan, Stansfeld Stephen
Division of Community Health Sciences, St George's University of London, Cranmer Terrace, London, UK.
Int J Epidemiol. 2007 Jun;36(3):522-31. doi: 10.1093/ije/dyl309. Epub 2007 Jan 25.
It has been suggested that early life exposures are important determinants of geographical variations in adult diseases. We examined inter-regional migrants in Britain to evaluate the relative importance of early and recent exposures for adult cardiorespiratory risk factors, mental ill-health and sensory function.
A total of 9023 persons born throughout England, Scotland and Wales during 1 week in 1958 were followed periodically through childhood into adulthood. At 44-45 years, height, body mass index (BMI), blood pressure (BP), glycosylated haemoglobin, total and high-density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold at 4 kHz, visual impairment, symptoms of depression and anxiety, and chronic widespread pain were measured. Analysis of migration between 12 regions included 3125 cohort members who were examined in a region different to their birthplace.
Height, BMI, diastolic BP (DBP), FEV1, log-transformed IgE and hearing threshold varied by region among non-migrants (each P < 0.05). Among inter-regional migrants, the spatial associations with current region, independent of birthplace, followed closely the geographical pattern shown among non-migrants for BMI, DBP and FEV1 (each P < 0.001). In contrast, of the 15 outcomes, only adult height was related to region of birth, after adjustment for region of examination (P = 0.002)
Although individual disease risk is predicted by early life factors, early exposures do not explain regional variations in cardiovascular and respiratory risk factors among middle-aged adults in Britain. Geographical inequalities in cardiorespiratory health are more strongly related to factors associated with region of examination that influence obesity, BP and ventilatory function.
有研究表明，早年暴露是成人疾病地理差异的重要决定因素。我们对英国的区域间移民进行了研究，以评估早年暴露和近期暴露对成人心血管呼吸风险因素、心理健康问题和感觉功能的相对重要性。
1958年某一周内在英格兰、苏格兰和威尔士各地出生的9023人在童年期到成年期接受了定期随访。在44 - 45岁时，测量身高、体重指数（BMI）、血压（BP）、糖化血红蛋白、总胆固醇和高密度脂蛋白（HDL）胆固醇、甘油三酯、纤维蛋白原、总免疫球蛋白E（IgE）、一秒用力呼气量（FEV1）、4kHz听力阈值、视力障碍、抑郁和焦虑症状以及慢性广泛性疼痛。对12个地区之间的移民情况进行分析，其中包括3125名在出生地以外地区接受检查 cohort 成员。
在非移民中，身高、BMI、舒张压（DBP）、FEV1、对数转换后的IgE和听力阈值存在地区差异（均P < 0.05）。在区域间移民中，与当前地区的空间关联（独立于出生地）与非移民中BMI、DBP和FEV1所呈现的地理模式密切相关（均P < 0.001）。相比之下，在调整检查地区后，15项指标中只有成人身高与出生地区有关（P = 0.002）。
虽然个体疾病风险由早年因素预测，但早年暴露并不能解释英国中年成人中心血管和呼吸风险因素的地区差异。心肺健康方面的地理不平等与影响肥胖、血压和通气功能的检查地区相关因素关系更为密切。
