Cohen Beth, Vittinghoff Eric, Whooley Mary
Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Am J Cardiol. 2008 Feb 15;101(4):462-6. doi: 10.1016/j.amjcard.2007.09.093. Epub 2007 Dec 20.
Lower socioeconomic status (SES) was associated with reduced treadmill exercise capacity and predicted adverse cardiovascular outcomes. Why patients with low SES had reduced exercise capacity and whether this relation existed in patients with coronary heart disease (CHD) was not known. Using data from the Heart and Soul Study, the association of 4 indicators of SES (household income, education, housing status, and occupation) with treadmill exercise capacity was analyzed in 943 men and women with stable CHD. In multivariable linear regression models adjusted for demographic variables, co-morbidities, medication use, and health behaviors (smoking, alcohol use, body mass index, physical activity, and medication adherence), exercise capacity significantly decreased in a graded fashion from the highest to lowest categories of each SES variable (p <0.001 for all trends). Differences in exercise capacity between the lowest and highest SES categories were 2.4 METs for household income, 1.8 METs for education, 2.3 METs for housing, and 1.3 METs for occupation. In similarly adjusted logistic regression models comparing the lowest with the highest categories of SES, low SES was strongly associated with impaired exercise capacity (defined as <5 METs; odds ratios for income 5.5, 95% confidence interval [CI] 1.9 to 16.0; education 4.3, 95% CI 2.0 to 9.5; housing 4.5, 95% CI 2.1 to 9.6; and occupation 2.8, 95% CI 1.4 to 5.7, p <or=0.001 for all trends). In conclusion, 4 indicators of low SES were strongly associated with decreased exercise capacity in patients with CHD. Differences in traditional cardiac risk factors and health behaviors did not explain this association.
社会经济地位较低（SES）与跑步机运动能力下降相关，并可预测不良心血管结局。SES较低的患者运动能力为何下降，以及这种关系在冠心病（CHD）患者中是否存在尚不清楚。利用“心灵研究”的数据，对943例稳定型CHD男性和女性中SES的4项指标（家庭收入、教育程度、住房状况和职业）与跑步机运动能力的关联进行了分析。在针对人口统计学变量、合并症、药物使用和健康行为（吸烟、饮酒、体重指数、身体活动和药物依从性）进行调整的多变量线性回归模型中，运动能力随着每个SES变量从最高类别到最低类别呈分级显著下降（所有趋势的p<0.001）。SES最低和最高类别之间的运动能力差异，家庭收入为2.4代谢当量，教育程度为1.8代谢当量，住房为2.3代谢当量，职业为1.3代谢当量。在将SES最低类别与最高类别进行比较的类似调整逻辑回归模型中，低SES与运动能力受损密切相关（定义为<5代谢当量；收入的优势比为5.5，95%置信区间[CI]为1.9至16.0；教育程度为4.3，95%CI为2.0至9.5；住房为4.5，95%CI为2.1至9.6；职业为2.8，95%CI为1.4至5.7，所有趋势的p≤0.001）。总之，低SES的4项指标与CHD患者运动能力下降密切相关。传统心脏危险因素和健康行为的差异并不能解释这种关联。
