儿童期、青少年期及成年期的社会经济状况与缺血性中风风险
Socioeconomic Conditions in Childhood, Adolescence, and Adulthood and the Risk of Ischemic Stroke.
作者信息
Becher Heiko, Palm Frederick, Aigner Annette, Safer Anton, Urbanek Christian, Buggle Florian, Grond-Ginsbach Caspar, Grau Armin J
机构信息
From the Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.B., A.A.); Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany (F.P., C.U., F.B., A.J.G.); Institute of Public Health, University of Heidelberg, Heidelberg, Germany (H.B., A.S.); and Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany (C.G.-G.).
出版信息
Stroke. 2016 Jan;47(1):173-9. doi: 10.1161/STROKEAHA.115.011523. Epub 2015 Nov 24.
BACKGROUND AND PURPOSE
The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood.
METHODS
Within a population-based stroke registry, we performed a case-control study with 470 ischemic stroke patients (cases) aged 18 to 80 years and 809 age- and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period.
RESULTS
Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood. Using tertiles of score values, low socioeconomic conditions during childhood (odds ratio 1.77; 95% confidence interval 1.20-2.60) and adulthood (odds ratio 1.74; 95% confidence interval 1.16-2.60) but not significantly during adolescence (odds ratio 1.64; 95% confidence interval 0.97-2.78) were associated with stroke risk after adjustment for risk factors and other life stages. Medical risk factors attenuated the effect of childhood conditions, and lifestyle factors reduced the effect of socioeconomic conditions in adolescence and adulthood. Unfavorable childhood socioeconomic conditions were particularly associated with large artery atherosclerotic stroke in adulthood (odds ratio 2.13; 95% confidence interval 1.24-3.67).
CONCLUSIONS
This study supports the hypothesis that unfavorable childhood socioeconomic conditions are related to ischemic stroke risk, independent of established risk factors and socioeconomic status in adulthood, and fosters the idea that stroke prevention needs to begin early in life.
背景与目的
成年期社会经济地位与中风风险之间的关联已得到充分证实；然而，不同生命阶段社会经济状况的独立影响却鲜为人知。
方法
在一个基于人群的中风登记处内，我们进行了一项病例对照研究，研究对象为470名年龄在18至80岁之间的缺血性中风患者（病例组）以及809名年龄和性别匹配的无中风对照者，这些对照者是从人群中随机选取的（研究时间段为2007年10月至2012年4月）。我们评估了童年、青少年和成年期的社会经济状况，并为每个生命阶段制定了社会经济风险评分。
结果
在病例组中，童年时期父亲的职业、生活条件和估计家庭收入、青少年时期的学历和职业培训、成年期的最后职业、婚姻状况和失业期等方面的社会经济状况较差。使用评分值的三分位数，童年时期（比值比1.77；95%置信区间1.20 - 2.60）和成年期（比值比1.74；95%置信区间1.16 - 2.60）的低社会经济状况与中风风险相关，但在青少年时期不显著（比值比1.64；95%置信区间0.97 - 2.78），这是在对风险因素和其他生命阶段进行调整之后得出的。医学风险因素减弱了童年时期状况的影响，而生活方式因素降低了青少年和成年期社会经济状况的影响。不利的童年社会经济状况尤其与成年期的大动脉粥样硬化性中风相关（比值比2.13；95%置信区间1.24 - 3.67）。
结论
本研究支持这样一种假设，即不利的童年社会经济状况与缺血性中风风险相关，独立于既定的风险因素和成年期的社会经济地位，并强化了中风预防需要在生命早期就开始的观点。
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