Helmert U, Shea S, Herman B, Greiser E
Department of Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Federal Republic of Germany.
Public Health. 1990 Nov;104(6):399-416. doi: 10.1016/s0033-3506(05)80083-6.
A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.
对德国心血管疾病预防研究基线调查进行了横断面分析，以分析四种不同社会阶层特征与冠心病主要危险因素之间的关系。1984年至1986年期间，4796名年龄在25 - 69岁之间的德国居民被随机抽取参与健康调查。应答率为66.2%。未观察到高血压、高胆固醇血症或低高密度脂蛋白患病率与社会阶层变量之间存在显著关联。多元逻辑回归分析显示，肥胖和缺乏体育活动在社会阶层较低的男女中更为普遍，而吸烟仅在男性中存在这种关系。在缺乏体育活动方面发现了最强的社会阶层梯度，按综合指数比较最低社会阶层与最高社会阶层，调整后的优势比为4.75，P小于0.001。每名研究对象的冠心病危险因素数量随着社会阶层的降低而显著增加。以受教育年限衡量的教育程度与冠心病危险因素的关联比家庭收入、职业地位或社会阶层的三维综合指数更强。这些发现表明，在开展基于社区的冠心病一级预防项目时，需要关注社会阶层较低的人群，特别是在吸烟、肥胖和缺乏体育活动方面。
