Woodward M, Shewry M C, Smith W C, Tunstall-Pedoe H
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Prev Med. 1992 Jan;21(1):136-48. doi: 10.1016/0091-7435(92)90013-8.
Social status has frequently been found to be associated with the prevalence of coronary heart disease. Currently, in developed countries, it seems that the least advantaged social groups are at the greatest risk. This article addresses this issue in the Scottish population, using a cross-sectional sample of 10,359 men and women. Four measures of social status are used: level of education, years of education, housing tenure, and the Office of Population Censuses and Surveys' definition of social class based on occupation. By each of these four criteria, and for both sexes, the least advantaged have a significantly higher coronary heart disease prevalence (P less than 0.01). The odds ratios for housing tenure are highest, being 1.63 and 1.55 for men and women, respectively, comparing those who live in rented accommodation with owner-occupiers. After adjustment for a number of coronary heart disease risk factors, which are possible confounding variables, most, if not all, of the significant effect of education and occupation on coronary heart disease is removed. Housing tenure is still highly significant (P less than 0.001), with odds ratios of 1.48 and 1.45 for men and women, respectively. Smoking and fibrinogen are the most important confounding variables for men, and body mass index, high-density lipoprotein cholesterol, and triglyceride levels, the most important for women. When relationships among the social factors themselves are investigated, housing tenure is found to remove the significant effects of education and occupation in men, and of education in women. No other social factor removes the significant effect of housing tenure (P less than 0.001). Housing tenure in Scotland is thus found to be the most discriminatory measure of social status in relation to coronary heart disease.
社会地位经常被发现与冠心病的患病率相关。目前，在发达国家，似乎最弱势群体面临的风险最大。本文以10359名男性和女性的横断面样本为基础，探讨了苏格兰人群中的这一问题。使用了四种社会地位衡量指标：教育水平、受教育年限、住房保有 tenure、以及人口普查与调查办公室基于职业对社会阶层的定义。根据这四个标准中的每一个，无论男女，最弱势群体的冠心病患病率都显著更高（P小于0.01）。住房保有 tenure的优势比最高，将租房者与自有住房者相比，男性和女性的优势比分别为1.63和1.55。在对一些可能作为混杂变量的冠心病危险因素进行调整后，教育和职业对冠心病的大部分（如果不是全部）显著影响被消除。住房保有 tenure仍然具有高度显著性（P小于0.001），男性和女性的优势比分别为1.48和1.45。吸烟和纤维蛋白原是男性最重要的混杂变量，而体重指数、高密度脂蛋白胆固醇和甘油三酯水平是女性最重要的混杂变量。当研究社会因素之间的关系时，发现住房保有 tenure消除了教育和职业对男性的显著影响，以及教育对女性的显著影响。没有其他社会因素能消除住房保有 tenure的显著影响（P小于0.001）。因此，在苏格兰，住房保有 tenure被发现是与冠心病相关的社会地位最具歧视性的衡量指标。
