Center for Social Epidemiology and Population Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.
Health Psychol. 2010 May;29(3):307-16. doi: 10.1037/a0019286.
We sought to understand the link between low socioeconomic position (SEP) and cardiovascular disease (CVD) by examining the association between SEP, health-related coping behaviors, and C-reactive protein (CRP), an inflammatory marker and independent risk factor for CVD, in a U.S. sample of adults.
We used a multiple mediation model to evaluate how these behaviors work in concert to influence CRP levels and whether these relationships were moderated by gender and race/ethnicity.
CRP levels were divided into two categories: elevated CRP (3.1-10.0 mg/L) and normal CRP (< or =3.0 mg/L).
Both poverty and low educational attainment were associated with elevated CRP, and these associations were primarily explained through higher levels of smoking and lower levels of exercise. In the education model, poor diet also emerged as a significant mediator. These behaviors accounted for 87.9% of the total effect of education on CRP and 55.8% the total effect of poverty on CRP. We also found significant moderation of these mediated effects by gender and race/ethnicity.
These findings demonstrate the influence of socioeconomically patterned environmental constraints on individual-level health behaviors. Specifically, reducing socioeconomic inequalities may have positive effects on CVD disparities through reducing cigarette smoking and increasing vigorous exercise.
通过考察社会经济地位（SEP）、与健康相关的应对行为与 C 反应蛋白（CRP）之间的关联，来了解低 SEP 与心血管疾病（CVD）之间的联系。CRP 是一种炎症标志物，也是 CVD 的独立危险因素。我们研究的对象是美国的成年人样本。
我们使用多重中介模型来评估这些行为如何协同影响 CRP 水平，以及这些关系是否受到性别和种族/民族的调节。
CRP 水平分为两类：CRP 升高（3.1-10.0mg/L）和 CRP 正常（≤3.0mg/L）。
贫困和教育程度低都与 CRP 升高有关，这些关联主要是通过更高水平的吸烟和更低水平的运动来解释的。在教育模型中，不良饮食也成为一个重要的中介因素。这些行为解释了教育对 CRP 总效应的 87.9%和贫困对 CRP 总效应的 55.8%。我们还发现这些中介效应受到性别和种族/民族的显著调节。
这些发现表明，社会经济模式的环境限制对个体健康行为有影响。具体来说，通过减少吸烟和增加剧烈运动，减少社会经济不平等可能对 CVD 差异产生积极影响。
