Division of General Medicine and Primary Care, Brigham and Women’s-Faulkner Hospitalist Program, Harvard Medical School, Boston, Massachusetts, USA.
BMC Public Health. 2012 Mar 20;12:211. doi: 10.1186/1471-2458-12-211.
Cardiovascular inflammation is a key contributor to the development of atherosclerosis and the prediction of cardiovascular events among healthy women. An emerging literature suggests biomarkers of inflammation vary by geography of residence at the state-level, and are associated with individual-level socioeconomic status. Associations between cardiovascular inflammation and state-level socioeconomic conditions have not been evaluated. The study objective is to estimate whether there are independent associations between state-level socioeconomic conditions and individual-level biomarkers of inflammation, in excess of individual-level income and clinical covariates among healthy women.
The authors examined cross-sectional multilevel associations among state-level socioeconomic conditions, individual-level income, and biomarkers of inflammation among women (n = 26,029) in the Women's Health Study, a nation-wide cohort of healthy women free of cardiovascular diseases at enrollment. High sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1) and fibrinogen were measured between 1993 and 1996. Biomarker levels were examined among women within quartiles of state-level socioeconomic conditions and within categories of individual-level income.
The authors found that favorable state-level socioeconomic conditions were correlated with lower hsCRP, in excess of individual-level income (e.g. state-level real per capital gross domestic product fixed effect standardized Βeta coefficient [Std B] -0.03, 95% CI -0.05, -0.004). Individual-level income was more closely associated with sICAM-1 (Std B -0.04, 95% CI -0.06, -0.03) and fibrinogen (Std B -0.05, 95% CI -0.06, -0.03) than state-level conditions.
We found associations between state-level socioeconomic conditions and hsCRP among healthy women. Personal household income was more closely associated with sICAM-1 and fibrinogen than state-level socioeconomic conditions. Additional research should examine these associations in other cohorts, and investigate what more-advantaged states do differently than less-advantaged states that may influence levels of cardiovascular inflammation among healthy women.
心血管炎症是动脉粥样硬化发展和健康女性心血管事件预测的关键因素。新出现的文献表明，炎症生物标志物因州级居住地区而异，并与个体的社会经济地位相关。心血管炎症与州级社会经济状况之间的关联尚未得到评估。本研究旨在评估在健康女性中，州级社会经济状况与个体炎症生物标志物之间是否存在独立关联，而不仅仅是个体收入和临床协变量的影响。
作者在妇女健康研究（一项全国范围内的健康女性心血管疾病无发病队列）中，研究了州级社会经济状况、个体收入和炎症生物标志物之间的横断面多水平关联。1993 年至 1996 年期间，测量了高敏 C 反应蛋白（hsCRP）、可溶性细胞间黏附分子-1（sICAM-1）和纤维蛋白原的水平。在女性中，根据州级社会经济状况四分位数和个体收入类别，对生物标志物水平进行了检查。
作者发现，有利的州级社会经济状况与 hsCRP 呈负相关，而与个体收入无关（例如，州级实际人均国内生产总值固定效应标准化β系数[Std B] -0.03，95%CI -0.05，-0.004）。个体收入与 sICAM-1（Std B -0.04，95%CI -0.06，-0.03）和纤维蛋白原（Std B -0.05，95%CI -0.06，-0.03）的相关性更为密切，而不是州级社会经济状况。
我们发现健康女性的州级社会经济状况与 hsCRP 之间存在关联。个人家庭收入与 sICAM-1 和纤维蛋白原的相关性比州级社会经济状况更为密切。进一步的研究应该在其他队列中检验这些关联，并探讨较富裕的州与较贫困的州在哪些方面有所不同，这些不同可能会影响健康女性的心血管炎症水平。
