Kamphuis Carlijn B M, Turrell Gavin, Giskes Katrina, Mackenbach Johan P, van Lenthe Frank J
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Int J Cardiol. 2013 Oct 3;168(3):2207-13. doi: 10.1016/j.ijcard.2013.01.219. Epub 2013 Feb 27.
Our goal was to study associations between childhood socioeconomic position (SEP), adulthood SEP, adulthood risk factors and cardiovascular disease (CVD) mortality, by investigating the critical period and pathway models.
The prospective GLOBE study in the Netherlands, with baseline data from 1991, was linked with cause of death register data from Statistics Netherlands in 2007. At baseline, respondents reported information on childhood SEP (i.e. occupational level of respondent's father), adulthood SEP (educational level), and adulthood risk factors (health behaviours, material circumstances, and psychosocial factors). Analyses included 4894 men and 5572 women. Data were analysed by Cox proportional hazard ratios (HR) with CVD mortality as the outcome.
Childhood SEP was associated with CVD mortality among men with the lowest childhood SEP only (HR 1.32, 95% CI 1.00-1.74), and not among women. The majority of childhood SEP inequalities in CVD mortality among men (88%) were explained by material, behavioural and psychosocial risk factors in adulthood, and adulthood SEP. This was mostly due to the association of childhood SEP with adulthood SEP, and the interrelations of adulthood SEP with risk factors, and partly via the direct association of childhood SEP with adulthood risk factors, independent of adulthood SEP.
This study supports the pathway model for men, but found no evidence that socioeconomic conditions in childhood are critical for CVD mortality in later life independent of adulthood conditions. Developing effective methods to reduce material and behavioural risk factors among lower socioeconomic groups should be a top priority in cardiovascular disease prevention.
我们的目标是通过研究关键期和路径模型，探讨儿童社会经济地位（SEP）、成年期SEP、成年期风险因素与心血管疾病（CVD）死亡率之间的关联。
荷兰的前瞻性全球健康研究（GLOBE），其1991年的基线数据与荷兰统计局2007年的死亡原因登记数据相链接。在基线时，受访者报告了关于儿童SEP（即受访者父亲的职业水平）、成年期SEP（教育水平）和成年期风险因素（健康行为、物质环境和心理社会因素）的信息。分析纳入了4894名男性和5572名女性。数据采用Cox比例风险比（HR）进行分析，以CVD死亡率作为结局。
仅在儿童SEP最低的男性中，儿童SEP与CVD死亡率相关（HR 1.32，95%CI 1.00 - 1.74），而在女性中未发现这种关联。男性CVD死亡率中大部分儿童SEP不平等（88%）可由成年期的物质、行为和心理社会风险因素以及成年期SEP来解释。这主要是由于儿童SEP与成年期SEP的关联，以及成年期SEP与风险因素的相互关系，部分还通过儿童SEP与成年期风险因素的直接关联，且独立于成年期SEP。
本研究支持男性的路径模型，但没有证据表明童年时期的社会经济状况对成年后CVD死亡率至关重要，且独立于成年期状况。开发有效的方法来降低社会经济地位较低群体中的物质和行为风险因素，应成为心血管疾病预防的首要任务。
