Mosquera Paola A, San Sebastian Miguel, Waenerlund Anna-Karin, Ivarsson Anneli, Weinehall Lars, Gustafsson Per E
Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden.
Social Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden.
Soc Sci Med. 2016 Jan;149:135-44. doi: 10.1016/j.socscimed.2015.12.017. Epub 2015 Dec 15.
While the social determinants of cardiovascular disease (CVD) are fairly well-known, the determinants of socioeconomic inequalities in CVD are scarcely studied and almost completely based on cross-sectional designs in which the changing circumstances across the life course are not taken into account. The present study seeks to incorporate a life course approach to the social determinants of socioeconomic inequalities in CVD. The specific aims were to 1) examine how income-related inequalities in CVD change over two decades of the mid-late life course, and 2) identify the key social determinants of the inequalities at each time period. The cohort (N = 44,039) comprised all individuals aged 40-60 years in 1990 who during 1990-2010 were enrolled in the county-wide preventive effort :"Västerbotten Intervention Program" (VIP). The cohort was followed over these two decades by Swedish population register data linked within the Umeå SIMSAM Lab micro data infrastructure. First-time hospitalization for CVD and mean earned income were used to calculate the concentration index (C) during four periods of 5-6 years. The C for each period was decomposed by sociodemographic factors, using Wagstaff-type decomposition analysis. Results suggest that inequalities in CVD increase gradually from mid-life to old age; from initially non-significant to particularly marked among the elderly. The decomposition showed that, from middle to old age, educational and employment inequalities underwent a transition from initially dominant to a moderate role in explaining the health inequalities, coupled with an increasing importance of age and a stable role of income. In conclusion, the study illustrates the need for incorporating a dynamic life course perspective into research, policy and practice concerned with equity in health.
虽然心血管疾病（CVD）的社会决定因素已广为人知，但CVD社会经济不平等的决定因素却鲜有研究，且几乎完全基于横断面设计，未考虑生命历程中不断变化的情况。本研究旨在将生命历程方法纳入CVD社会经济不平等的社会决定因素研究。具体目标是：1）研究CVD中与收入相关的不平等在中年后期的二十年中如何变化；2）确定每个时间段不平等的关键社会决定因素。该队列（N = 44,039）包括1990年年龄在40 - 60岁之间且在1990 - 2010年期间参与全县预防工作“韦斯特博滕干预计划”（VIP）的所有个体。通过在于默奥SIMSAM实验室微观数据基础设施内链接的瑞典人口登记数据，对该队列进行了这二十年的跟踪研究。使用首次因CVD住院和平均劳动收入来计算5 - 6年四个时间段的集中指数（C）。利用瓦格斯塔夫类型的分解分析，按社会人口因素对每个时间段的C进行分解。结果表明，CVD的不平等从中年到老年逐渐增加；从最初不显著到在老年人中尤为明显。分解结果显示，从中年到老年，教育和就业不平等在解释健康不平等方面经历了从最初占主导地位到适度作用的转变，同时年龄的重要性增加，收入的作用保持稳定。总之，该研究表明有必要将动态生命历程视角纳入与健康公平相关的研究、政策和实践中。
