Food Science and Nutrition, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
Soc Sci Med. 2010 Apr;70(8):1229-36. doi: 10.1016/j.socscimed.2009.12.014. Epub 2010 Feb 4.
Socioeconomic factors are associated with cardiovascular disease. C-reactive protein (CRP) is increasingly implicated as a candidate linking conventional risk factors and atherosclerosis. The impact of early- and later-life socioeconomic status (SES) on CRP levels has not been widely investigated and a handful of studies from high-income countries are inconsistent. We set out to examine the associations between lifecourse socioeconomic indicators (family income at birth, maternal education, family income at age 23 and own education) on CRP levels in young adults belonging to the 1982 Pelotas (Brazil) Birth Cohort Study (n=5914). Early-life SES showed significant and graded associations with CRP levels at age 23 independently of later SES. For example, men with higher family income at birth showed higher CRP levels at age 23 (p=0.001 for trend) and women with less educated mothers showed higher CRP levels (p=0.01 for trend). Notably, differential directions of association between SES indicators and CRP levels between men and women were found. When adjusted for SES at age 23, men with the lowest family income at birth showed 42% lower CRP levels when compared to men in the highest family income group (-42; 95% CI: -60,-16). In contrast women born to the least educated mothers had the highest CRP levels (35; 95% CI -2, 86). In both sexes, adiposity accounted for the overwhelming majority of the associations between SES and CRP levels. Sex and gender roles specific to middle-income countries, socio-cultural and environmental conditions that may impact adiposity, and the level of epidemiological transition may be key factors that are linked to the associations between lifecourse SES and CRP levels. Public health strategies aimed at decreasing the burden of cardiovascular disease in middle-income settings, in addition to highlighting the risks associated with adult obesity, should not overlook the wide-ranging impacts of lifecourse social determinants.
社会经济因素与心血管疾病有关。C 反应蛋白（CRP）作为一种将传统危险因素与动脉粥样硬化联系起来的候选物质，其作用越来越受到关注。早期和后期社会经济地位（SES）对 CRP 水平的影响尚未得到广泛研究，少数来自高收入国家的研究结果也不一致。我们旨在研究 1982 年佩洛塔斯（巴西）出生队列研究（n=5914）中年轻成年人的一生中社会经济指标（出生时家庭收入、母亲教育程度、23 岁时家庭收入和自身教育程度）与 CRP 水平之间的关系。早期社会经济状况与 23 岁时 CRP 水平有显著的、分级的关联，与后期社会经济状况无关。例如，出生时家庭收入较高的男性在 23 岁时 CRP 水平较高（趋势 P=0.001），母亲受教育程度较低的女性 CRP 水平较高（趋势 P=0.01）。值得注意的是，男女 SES 指标与 CRP 水平之间的关联方向存在差异。在调整 23 岁时 SES 后，与收入最高的家庭相比，出生时家庭收入最低的男性 CRP 水平低 42%（-42；95%CI：-60，-16）。相比之下，出生时母亲受教育程度最低的女性 CRP 水平最高（35；95%CI：2，86）。在两性中，肥胖解释了 SES 与 CRP 水平之间绝大多数的关联。中低收入国家特有的性别角色和社会文化环境条件可能会影响肥胖程度，以及流行病学转变的水平，这些可能是与一生中 SES 与 CRP 水平之间关联有关的关键因素。旨在减少中低收入环境中心血管疾病负担的公共卫生策略，除了强调与成年肥胖相关的风险外，不应忽视一生中社会决定因素的广泛影响。
