School of Sport, Exercise and Health Sciences, Loughborough University, UK.
J Biosoc Sci. 2012 Jul;44(4):433-58. doi: 10.1017/S0021932012000107. Epub 2012 Apr 11.
Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n = 358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (β = 3.52, SE = 1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.
在高收入国家，人们已经对导致心血管疾病高危的因素进行了深入研究，但在中低收入国家，这些因素的研究却相对较少。尽管这些国家存在着强有力的环境变迁理论证据，这些变迁可能导致生物适应性的改变，从而增加高血压和心血管疾病的风险，但这一点并没有得到很好的研究。本研究利用南非出生至二十岁队列研究的骨骼健康子样本（n=358，47%为女性）的数据，采用多元线性回归模型分析婴儿期家庭社会经济状况（SES）、16 岁时家庭/邻里 SES 与收缩压之间的关系，采用二项逻辑回归模型分析收缩压前期高血压的风险。单变量分析显示，家庭/邻里 SES 指标与收缩压显著相关。这些显著相关的指标包括婴儿期/16 岁时家庭卫生改善、婴儿期时照顾者拥有住房，以及 16 岁时处于学校问题/环境、邻里服务/问题/犯罪指数较高 tertile（较高 SES）。多元分析调整了性别、母亲年龄、出生体重、产次、吸烟、足月出生、16 岁时的身高/体重指数。在调整分析中，只有一个 SES 变量对女性有显著影响：处于犯罪预防指数中 tertile 中位数的女性收缩压较高（β=3.52，SE=1.61），而 tertile 最高的女性（即犯罪预防指数最高的女性）则收缩压较低。在调整分析中，SES 变量与男孩的收缩压或男女收缩压前期高血压的风险均无显著相关性。16 岁时 SES 与收缩压/收缩压前期高血压之间缺乏关联，这与其他研究表明青少年健康不平等现象均等化的结果一致。建议在成年期进一步测试 SES 与收缩压之间的关系，以观察这种关联是否持续存在。
