Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
Am J Public Health. 2012 Dec;102(12):2344-51. doi: 10.2105/AJPH.2012.300774. Epub 2012 Oct 18.
We explored the notion that social disadvantage increases vulnerability to the health effects of environmental hazards. Specifically, we examined (1) whether race modifies the association between blood lead and blood pressure and (2) whether socioeconomic status (SES) plays a role in this modifying effect.
Using the National Health and Nutrition Examination Survey (2001-2008) and linear regression, we estimated the association between blood lead and blood pressure. Using interactions among race, SES, and lead, we estimated this association by levels of social disadvantage.
Black men and women showed a 2.8 (P < .001) and 4.0 (P < .001) millimeters mercury increase in SBP, respectively, for each doubling of blood lead. White adults showed no association. This lead-SBP association exhibited by Blacks was primarily isolated to Blacks of low SES. For example, poor but not nonpoor Black men showed a 4.8 millimeters mercury (P < .001) increase in SBP for each doubling of blood lead.
Our results suggest that social disadvantage exacerbates the deleterious health effects of lead. Our work provides evidence that social and environmental factors must be addressed together to eliminate health disparities.
我们探讨了社会劣势是否会增加对环境危害健康影响的脆弱性。具体而言，我们研究了（1）种族是否会改变血液铅与血压之间的关联，以及（2）社会经济地位（SES）是否在这种修饰作用中发挥作用。
我们利用国家健康和营养检查调查（2001-2008 年）和线性回归来估计血液铅与血压之间的关联。通过种族、SES 和铅之间的相互作用，我们根据社会劣势的程度来估计这种关联。
黑人男性和女性的 SBP 分别增加了 2.8（P<0.001）和 4.0（P<0.001）毫米汞柱，每增加一倍血铅。白人成年人没有关联。黑人表现出的这种铅-SBP 关联主要局限于 SES 较低的黑人。例如，贫穷但非贫困的黑人男性的 SBP 每增加一倍血铅就会增加 4.8 毫米汞柱（P<0.001）。
我们的结果表明，社会劣势加剧了铅对健康的有害影响。我们的工作提供了证据，表明必须同时解决社会和环境因素，以消除健康差距。
