早期生活中的社会经济劣势与代谢健康差异。
Early-Life Socioeconomic Disadvantage and Metabolic Health Disparities.
作者信息
Hostinar Camelia E, Ross Kharah M, Chen Edith, Miller Gregory E
机构信息
From the Psychology Department (Hostinar), University of California, Davis, California; Psychology Department (Ross), University of California, Los Angeles, California; and Psychology Department and Institute for Policy Research (Chen, Miller), Northwestern University, Evanston, Illinois.
出版信息
Psychosom Med. 2017 Jun;79(5):514-523. doi: 10.1097/PSY.0000000000000455.
OBJECTIVE
A quarter of the world's population have metabolic syndrome (MetS). MetS prevalence is stratified by socioeconomic status (SES), such that low SES is associated with higher MetS risk. The present study examined the relative roles of early-life SES and current SES in explaining MetS risk.
METHODS
Participants (N = 354; ages = 15-55 years, M [SD] = 36.5 [10.7] years; 55% female; 72.9% white, 16.9% Asian, 10.2% others) were evaluated for SES and MetS. All were in good health, defined as free of chronic medical illness and acute infectious disease. Using occupational status as a proxy for SES, we recruited roughly equal numbers of participants with low-low, low-high, high-low, and high-high combinations of early-life and current SES. We used the International Diabetes Federation definition for MetS using race- and sex-specific cutoffs for waist circumference, triglyceride levels, high-density lipoprotein cholesterol, blood pressure, and glycosylated hemoglobin levels.
RESULTS
Analyses revealed a main effect of low early-life SES on increased MetS risk according to the three separate definitions. They included the traditional MetS diagnosis (odds ratio [OR] = 1.53, confidence interval [CI] = 1.01-2.33, p = .044), the number of MetS components for which diagnostic thresholds were met (OR = 1.61, CI = 1.10-2.38, p = .015), and a continuous indicator of metabolic risk based on factor analysis (F(1,350) = 6.71, p = .010, partial η = .019). There was also a significant interaction of early-life SES and current SES in predicting MetS diagnosis (OR = 1.54, CI = 1.02-2.34). The main effects of current SES were nonsignificant in all analyses.
CONCLUSIONS
These findings suggest that MetS health disparities originate in childhood, which may be an opportune period for interventions.
目的
全球四分之一的人口患有代谢综合征（MetS）。MetS患病率按社会经济地位（SES）分层，低SES与更高的MetS风险相关。本研究探讨了早年SES和当前SES在解释MetS风险方面的相对作用。
方法
对参与者（N = 354；年龄 = 15 - 55岁，M[标准差] = 36.5[10.7]岁；55%为女性；72.9%为白人，16.9%为亚洲人，10.2%为其他种族）进行SES和MetS评估。所有参与者健康状况良好，定义为无慢性疾病和急性传染病。以职业地位作为SES的代理指标，我们招募了早年和当前SES组合为低 - 低、低 - 高、高 - 低和高 - 高的大致相等数量的参与者。我们使用国际糖尿病联盟对MetS的定义，采用针对种族和性别的腰围、甘油三酯水平、高密度脂蛋白胆固醇、血压和糖化血红蛋白水平的截断值。
结果
分析显示，根据三种不同定义，早年低SES对MetS风险增加有主要影响。这些定义包括传统的MetS诊断（比值比[OR] = 1.53，置信区间[CI] = 1.01 - 2.33，p = 0.044）、达到诊断阈值的MetS组分数量（OR = 1.61，CI = 1.10 - 2.38，p = 0.015）以及基于因子分析的代谢风险连续指标（F(1,350) = 6.71，p = 0.010，偏η² = 0.019）。在预测MetS诊断方面，早年SES和当前SES之间也存在显著交互作用（OR = 1.54，CI = 1.02 - 2.34）。在所有分析中，当前SES的主要影响均不显著。
结论
这些发现表明，MetS健康差异始于儿童期，这可能是进行干预的有利时机。
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