Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Department of Epidemiology, Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX.
J Am Heart Assoc. 2018 Feb 6;7(3):e007693. doi: 10.1161/JAHA.117.007693.
Economic literature shows that a child's future earnings are predictably influenced by parental income, providing an index of "socioeconomic mobility," or the ability of a person to move towards a higher socioeconomic status from childhood to adulthood. We adapted this economic paradigm to examine cardiovascular risk mobility (CRM), or whether there is life course mobility in relative cardiovascular risk.
Participants from the BHS (Bogalusa Heart Study) with 1 childhood and 1 adult visit from 1973 to 2016 (n=7624) were considered. We defined population-level CRM as the rank-rank slope (β) from the regression of adult cardiovascular disease (CVD) risk percentile ranking onto childhood CVD risk percentile ranking (β=0 represents complete mobility; β=1 represents no mobility). After defining and measuring relative CRM, we assessed its correlation with absolute cardiovascular health using the American Heart Association's Ideal Cardiovascular Health metrics. Overall, there was substantial mobility, with black participants having marginally better CRM than whites (β=0.10 [95% confidence interval, 0.05-0.15]; β=0.18 [95% confidence interval, 0.14-0.22]; =0.01). Having high relative CVD risk at an earlier age significantly reduced CRM (β=-0.02; 95% confidence interval, -0.03 to -0.01; <0.001). Relative CRM was strongly correlated with life course changes in Ideal Cardiovascular Health sum (=0.62; 95% confidence interval, 0.60-0.65).
Results from this novel application of an economic mobility index to cardiovascular epidemiology indicated substantial CRM, supporting the paradigm that life course CVD risk is highly modifiable. High CRM implies that the children with the best relative CVD profiles may only maintain a slim advantage over their peers into adulthood.
经济文献表明，孩子未来的收入可预测地受到父母收入的影响，这提供了一个“社会经济流动性”的指标，即一个人从童年到成年向更高社会经济地位移动的能力。我们将这一经济范式应用于心血管风险流动性（CRM）的研究，即心血管风险是否存在生命历程中的流动性。
我们考虑了 BHS（博加卢萨心脏研究）中的参与者，他们在 1973 年至 2016 年期间进行了 1 次儿童期和 1 次成年期访问（n=7624）。我们将人群水平的 CRM 定义为成年期心血管疾病（CVD）风险百分位排名与儿童期 CVD 风险百分位排名之间的回归的秩秩斜率（β）（β=0 表示完全流动性；β=1 表示无流动性）。在定义和测量相对 CRM 后，我们使用美国心脏协会的理想心血管健康指标评估了其与绝对心血管健康的相关性。总体而言，存在大量的流动性，黑人参与者的 CRM 略优于白人（β=0.10[95%置信区间，0.05-0.15]；β=0.18[95%置信区间，0.14-0.22]；=0.01）。早年患有较高的相对 CVD 风险会显著降低 CRM（β=-0.02；95%置信区间，-0.03 至-0.01；<0.001）。相对 CRM 与理想心血管健康总和的生命历程变化密切相关（=0.62；95%置信区间，0.60-0.65）。
该经济流动性指数在心血管流行病学中的新颖应用结果表明存在大量的 CRM，支持了生命历程 CVD 风险高度可改变的范式。高 CRM 意味着具有最佳相对 CVD 特征的儿童可能在成年后仅能保持对其同龄人的微小优势。
