School of Public Health, The University of Hong Kong, Units 624-627, Core F, Cyberport 3, Pokfulam, Hong Kong SAR, China.
J Epidemiol Community Health. 2010 Nov;64(11):941-9. doi: 10.1136/jech.2008.086553. Epub 2010 Jun 1.
This study places social disparities in the major non-communicable chronic diseases within their global economic and historical contexts. Rapid economic transition outside the developed world provides a unique opportunity to re-examine the origins of, and biological mechanisms driving, social disparities. Gaps in prevailing theories focusing on material resources, civic infrastructure and social structure are identified. Using longstanding experimental evidence and epigenetic theories, it is suggested that exposure to economic development over generations (ie, improved living conditions over historical time) could by acting on different biological axes (somatotrophic and gonadotrophic) generate specific patterns of social disparities. Moreover, these same processes could initially generate a transient epidemic of diabetes as well as a permanent increase in male risk of premature ischaemic heart disease. As such, this study demonstrates the importance of context, and implies that current evidence from the developed world may be largely uninformative for preventing or mitigating social disparities in non-communicable chronic diseases elsewhere, suggesting research efforts should be focused on developing countries.
本研究将主要非传染性慢性病中的社会差异置于其全球经济和历史背景下进行考察。在发达国家之外，快速的经济转型为重新审视社会差异的起源及其背后的生物学机制提供了独特的机会。本研究还指出了目前聚焦于物质资源、公民基础设施和社会结构的主流理论存在的空白。通过长期的实验证据和表观遗传学理论，本研究提出，几代人经历的经济发展（即，历史上生活条件的改善）可能通过作用于不同的生物学轴（躯体营养和性腺营养），产生特定的社会差异模式。此外，这些相同的过程最初可能会导致糖尿病的短暂流行，以及男性过早发生缺血性心脏病风险的永久性增加。因此，本研究表明了背景的重要性，并暗示目前来自发达国家的证据在预防或减轻其他地方非传染性慢性病中的社会差异方面可能基本没有帮助，这表明研究工作应侧重于发展中国家。
