Erqou Sebhat, Echouffo-Tcheugui Justin B, Kip Kevin E, Aiyer Aryan, Reis Steven E
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Medicine, Brigham Women's Hospital, Boston, MA, USA.
BMC Cardiovasc Disord. 2017 May 8;17(1):110. doi: 10.1186/s12872-017-0539-9.
Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes.
Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17).
An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.
量化社会风险因素对心血管疾病（CVD）风险的累积影响有助于更好地理解健康结果差异的来源。
来自聚焦风险评估的心脏策略（HeartSCORE）研究的数据用于创建累积社会风险（CSR）指数，并量化其与CVD事件和全因死亡率的关联。CSR通过为4种社会因素中的每一种存在情况赋予1分来定义：i）少数族裔身份（黑人种族），ii）单身生活状态，iii）低收入，以及iv）低教育水平。使用Cox回归模型计算风险比（HRs），并对CVD风险因素进行调整。在中位随访期8.3年期间，观察到127例事件。CSR评分为0、1和≥2的参与者亚组的主要结局发生率分别为每1000人年5.31（95%CI，3.40 - 7.22）、10.32（7.16 - 13.49）和17.80（12.94 - 22.67）。与评分为0的个体相比，CSR评分为1的个体发生主要结局的调整后HR为1.85（1.15 - 2.97）。CSR评分为2或更高的个体的相应HR为2.58（1.60 - 4.17）。
社会风险因素的累积独立增加了白人和黑人队列中CVD事件和死亡的可能性。
