Centre for Women's Health, Gender & Society, Melbourne School of Population Health, The University of Melbourne, Australia.
Soc Sci Med. 2010 Sep;71(6):1150-60. doi: 10.1016/j.socscimed.2010.05.038. Epub 2010 Jun 23.
Socio-economic gradients in cardiovascular disease (CVD) and diabetes have been found throughout the developed world and there is some evidence to suggest that these gradients may be steeper for women. Research on social gradients in biological risk factors for CVD and diabetes has received less attention and we do not know the extent to which gradients in biomarkers vary for men and women. We examined the associations between two indicators of socio-economic position (education and household income) and biomarkers of diabetes and cardiovascular disease (CVD) for men and women in a national, population-based study of 11,247 Australian adults. Multi-level linear regression was used to assess associations between education and income and glucose tolerance, dyslipidaemia, blood pressure (BP) and waist circumference before and after adjustment for behaviours (diet, smoking, physical activity, TV viewing time, and alcohol use). Measures of glucose tolerance included fasting plasma glucose and insulin and the results of a glucose tolerance test (2 h glucose) with higher levels of each indicating poorer glucose tolerance. Triglycerides and High Density Lipoprotein (HDL) Cholesterol were used as measures of dyslipidaemia with higher levels of the former and lower levels of the later being associated with CVD risk. Lower education and low income were associated with higher levels of fasting insulin, triglycerides and waist circumference in women. Women with low education had higher systolic and diastolic BP and low income women had higher 2 h glucose and lower HDL cholesterol. With only one exception (low income and systolic BP), all of these estimates were reduced by more than 20% when behavioural risk factors were included. Men with lower education had higher fasting plasma glucose, 2 h glucose, waist circumference and systolic BP and, with the exception of waist circumference, all of these estimates were reduced when health behaviours were included in the models. While low income was associated with higher levels of 2-h glucose and triglycerides it was also associated with better biomarker profiles including lower insulin, waist circumference and diastolic BP. We conclude that low socio-economic position is more consistently associated with a worse profile of biomarkers for CVD and diabetes for women.
社会经济地位（Socio-economic Position，SEP）与心血管疾病（Cardiovascular Disease，CVD）和糖尿病之间的梯度关系在发达国家普遍存在，并且有一些证据表明，这些梯度在女性中可能更为陡峭。针对 CVD 和糖尿病生物风险因素的社会梯度研究受到的关注较少，我们也不清楚生物标志物的梯度在男性和女性之间存在多大的差异。在这项全国性的、基于人群的研究中，我们调查了澳大利亚 11247 名成年人中，两个社会经济地位指标（教育和家庭收入）与男性和女性的糖尿病和心血管疾病生物标志物之间的关联。使用多水平线性回归评估了教育和收入与葡萄糖耐量、血脂异常、血压（Blood Pressure，BP）和腰围之间的关联，并且在调整了行为因素（饮食、吸烟、身体活动、看电视时间和饮酒）后进行了分析。葡萄糖耐量的测量指标包括空腹血糖和胰岛素，以及葡萄糖耐量测试（2 小时血糖）的结果，其中每个指标的水平越高，表明葡萄糖耐量越差。甘油三酯和高密度脂蛋白胆固醇（High Density Lipoprotein Cholesterol，HDL-C）被用作血脂异常的测量指标，前者水平较高和后者水平较低与 CVD 风险相关。较低的教育程度和低收入与女性较高的空腹胰岛素、甘油三酯和腰围水平相关。教育程度较低的女性收缩压和舒张压较高，而低收入女性的 2 小时血糖较高，HDL-C 胆固醇水平较低。除了一个例外（低收入和收缩压），当纳入行为风险因素时，所有这些估计值都降低了 20%以上。教育程度较低的男性空腹血浆葡萄糖、2 小时血糖、腰围和收缩压水平较高，而当纳入健康行为模型时，除了腰围，所有这些估计值都降低了。虽然低收入与 2 小时血糖和甘油三酯水平较高有关，但也与更好的生物标志物特征相关，包括较低的胰岛素、腰围和舒张压。我们得出的结论是，社会经济地位较低与女性 CVD 和糖尿病的生物标志物更差的特征更一致相关。
