美国成年人全国 19 年前瞻性研究中死亡的社会经济和行为风险因素。

Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults.

机构信息

Department of Health Management & Policy, University of Michigan, School of Public Health, Ann Arbor, MI 48109-2029, United States.

出版信息

Soc Sci Med. 2010 May;70(10):1558-66. doi: 10.1016/j.socscimed.2010.02.003. Epub 2010 Feb 20.

Abstract

Many demographic, socioeconomic, and behavioral risk factors predict mortality in the United States. However, very few population-based longitudinal studies are able to investigate simultaneously the impact of a variety of social factors on mortality. We investigated the degree to which demographic characteristics, socioeconomic variables and major health risk factors were associated with mortality in a nationally-representative sample of 3617 U.S. adults from 1986 to 2005, using data from the 4 waves of the Americans' Changing Lives study. Cox proportional hazard models with time-varying covariates were employed to predict all-cause mortality verified through the National Death Index and death certificate review. The results revealed that low educational attainment was not associated with mortality when income and health risk behaviors were included in the model. The association of low income with mortality remained after controlling for major behavioral risks. Compared to those in the "normal" weight category, neither overweight nor obesity was significantly associated with the risk of mortality. Among adults age 55 and older at baseline, the risk of mortality was actually reduced for those were overweight (hazard rate ratio = 0.83) and those who were obese (hazard rate ratio = 0.68), controlling for other health risk behaviors and health status. Having a low level of physical activity was a significant risk factor for mortality (hazard rate ratio = 1.58). The results from this national longitudinal study underscore the need for health policies and clinical interventions focusing on the social and behavioral determinants of health, with a particular focus on income security, smoking prevention/cessation, and physical activity.

摘要

许多人口统计学、社会经济学和行为风险因素可预测美国的死亡率。然而,很少有基于人群的纵向研究能够同时调查各种社会因素对死亡率的影响。我们使用“美国人生活变化研究”的 4 个波次的数据,对来自美国的 3617 名成年人进行了全国代表性样本的研究,调查了人口统计学特征、社会经济变量和主要健康风险因素与死亡率的关联程度。通过时间变化的协变量 Cox 比例风险模型预测全因死亡率,通过国家死亡索引和死亡证明审核进行验证。结果表明,当收入和健康风险行为被纳入模型时,低教育程度与死亡率无关。在控制了主要行为风险后,低收入与死亡率的关联仍然存在。与处于“正常”体重类别的人相比,超重或肥胖与死亡率的风险无显著关联。在基线时年龄在 55 岁及以上的成年人中,超重(危险率比=0.83)和肥胖(危险率比=0.68)的人,其死亡率风险实际上降低了,同时控制了其他健康风险行为和健康状况。身体活动水平低是死亡率的一个显著风险因素(危险率比=1.58)。这项全国性纵向研究的结果强调,需要制定健康政策和临床干预措施,重点关注健康的社会和行为决定因素,特别关注收入保障、预防/戒烟和身体活动。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索