Crandall C J, Han W, Greendale G A, Seeman T, Tepper P, Thurston R, Karvonen-Gutierrez C, Karlamangla A S
Division of General Internal Medicine, David Geffen School of Medicine at University of California, 911 Broxton Ave., 1st floor, Los Angeles, CA, 90024, USA,
Osteoporos Int. 2014 Apr;25(4):1379-88. doi: 10.1007/s00198-013-2616-y. Epub 2014 Feb 7.
We examined baseline and annual follow-up data (through annual follow-up visit 9) from a cohort of 2,234 women aged 42 to 52 years at baseline. Independent of financial status, higher educational level was associated with lower fracture incidence among non-Caucasian women but not among Caucasian women.
This study was conducted to determine the associations of education and income with fracture incidence among midlife women over 9 years of follow-up.
We examined baseline and annual follow-up data (through annual follow-up visit 9) from 2,234 participants of the Study of Women's Health Across the Nation, a cohort of women aged 42 to 52 years at baseline. We used Cox proportional hazards regression models to examine the associations of socioeconomic predictors (education, family-adjusted poverty-to-income ratio, and difficulty paying for basics) with time to first incident nontraumatic, nondigital, noncraniofacial fracture.
Independent of family-adjusted poverty-to-income ratio, higher educational level was associated with decreased time to first incident fracture among non-Caucasian women but not among Caucasian women (p(interaction) 0.02). Compared with non-Caucasian women who completed no more than high school education, non-Caucasian women who attained at least some postgraduate education had 87% lower rates of incident nontraumatic fracture (adjusted hazard ratio 0.13, 95% confidence interval [CI] 0.03-0.60). Among non-Caucasian women, each additional year of education was associated with a 16% lower odds of nontraumatic fracture (adjusted odds ratio 0.84, 95% CI 0.73-0.97). Income, family-adjusted poverty-to-income ratio, and degree of difficulty paying for basic needs were not associated with time to first fracture in Caucasian or non-Caucasian women.
Among non-Caucasian midlife women, higher education, but not higher income, was associated with lower fracture incidence. Elucidation of the mechanisms underlying the possible protective effects of higher educational level on nontraumatic fracture incidence may allow us to better target individuals at risk of future fracture.
我们研究了一个基线时年龄在42至52岁的2234名女性队列的基线数据和年度随访数据（直至第9次年度随访）。与经济状况无关，较高的教育水平与非白人女性较低的骨折发生率相关，但与白人女性无关。
本研究旨在确定在9年随访期间教育和收入与中年女性骨折发生率之间的关联。
我们研究了全国妇女健康研究中2234名参与者的基线数据和年度随访数据（直至第9次年度随访），该队列女性基线年龄为42至52岁。我们使用Cox比例风险回归模型来研究社会经济预测因素（教育、家庭调整后的贫困收入比以及支付基本生活费用的困难程度）与首次发生非创伤性、非指骨、非颅面部骨折时间之间的关联。
与家庭调整后的贫困收入比无关，较高的教育水平与非白人女性首次发生骨折的时间缩短相关，但与白人女性无关（交互作用p值为0.02）。与未完成高中教育的非白人女性相比，至少接受过一些研究生教育的非白人女性发生非创伤性骨折的发生率低87%（调整后风险比为0.13，95%置信区间[CI]为0.03 - 0.60）。在非白人女性中，每增加一年教育与非创伤性骨折的几率降低16%相关（调整后优势比为0.84，95% CI为0.73 - 0.97）。收入、家庭调整后的贫困收入比以及支付基本生活需求的困难程度与白人或非白人女性首次骨折的时间无关。
在非白人中年女性中，较高的教育水平而非较高的收入与较低的骨折发生率相关。阐明较高教育水平对非创伤性骨折发生率可能的保护作用的潜在机制，可能使我们能够更好地针对未来骨折风险个体。
