Kaplan George A, Baltrus Peter T, Raghunathan Trivellore E
Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA.
Int J Epidemiol. 2007 Jun;36(3):542-8. doi: 10.1093/ije/dym008. Epub 2007 Mar 21.
Considerable evidence now exists indicating that incidence and progression of disease and disability are associated with socio-economic, behavioural, demographic and psychosocial factors. The emerging life course perspective suggests that these factors might be associated with not just the incidence of disease and death, but also trajectories of health over decades.
Prospective study of a representative, population-based cohort studied on four occasions over 30 years. Trajectories of health over this period, combining self-rated health and date of death, were related to behavioural, psychosocial and socio-economic risk factors.
Trajectories of health were associated with behavioural, socioeconomic, and psychosocial risk factors, the strongest predictors being household income and physical activity. Those with an income 1 SD above the mean were approximately 25% more likely to die having previously consistently reported excellent health (Men: relative risk (RR) = 1.27, 95% CI = 1.10-1.46; Women: RR = 1.25, 95% CI = 1.06-1.47), were more likely to remain 'Alive in Excellent Health' (Men: RR = 1.35, 95% CI = 1.21-1.51; Women: RR = 1.30, 95% CI = 1.19-1.43) and were less likely to have shown an 'Unremitting Decline' (Men: RR = 0.72, 95% CI = 0.49-1.05; Women: RR = 0.71, 95% CI = 0.48-1.04). Those with low physical activity were approximately 50% less likely to die having consistently reported excellent health (Men: RR = 0.54, 95% CI = 0.39-0.76; Women: RR = 0.48, 95% CI = 0.33-0.71), and were five-times more likely to show an 'Unremitting Decline' (Men: RR = 5.05, 95% CI = 1.75-14.56; Women: RR = 5.00, 95% CI = 1.48-16.92). They were also less likely to be 'Alive in Excellent Health' (Men: RR = 0.41, 95% CI = 0.29-0.57; Women: RR = 0.44, 95% CI = 0.33-0.57).
The burden of illness associated with behavioural, socio-economic and psychosocial risk factors extends beyond shortening of life to poorer trajectories of health over decades.
现在有大量证据表明，疾病和残疾的发生率及进展与社会经济、行为、人口统计学和心理社会因素相关。新出现的生命历程观点表明，这些因素不仅可能与疾病和死亡的发生率有关，还可能与数十年的健康轨迹有关。
对一个具有代表性的基于人群的队列进行前瞻性研究，在30年中进行了四次研究。在此期间，结合自评健康状况和死亡日期的健康轨迹与行为、心理社会和社会经济风险因素相关。
健康轨迹与行为、社会经济和心理社会风险因素相关，最强的预测因素是家庭收入和身体活动。收入比平均水平高1个标准差的人，在之前一直报告健康状况极佳的情况下死亡的可能性大约高25%（男性：相对风险（RR）=1.27，95%置信区间（CI）=1.10-1.46；女性：RR=1.25，95%CI=1.06-1.47），更有可能保持“健康存活”（男性：RR=1.35，95%CI=1.21-1.51；女性：RR=1.30，95%CI=1.19-1.43），且出现“持续下降”的可能性较小（男性：RR=0.72，95%CI=0.49-1.05；女性：RR=0.71，95%CI=0.48-1.04）。身体活动水平低的人，在一直报告健康状况极佳的情况下死亡的可能性大约低50%（男性：RR=0.54，95%CI=0.39-0.76；女性：RR=0.48，95%CI=0.33-0.71），出现“持续下降”的可能性高五倍（男性：RR=5.05，95%CI=1.75-14.56；女性：RR=5.00，95%CI=1.48-16.92）。他们“健康存活”的可能性也较小（男性：RR=0.41，95%CI=0.29-0.57；女性：RR=0.44，95%CI=0.33-0.57）。
与行为、社会经济和心理社会风险因素相关的疾病负担不仅会缩短寿命，还会导致数十年间更差的健康轨迹。
