National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
Am J Hypertens. 2018 May 7;31(6):672-678. doi: 10.1093/ajh/hpy026.
During the past 4 decades, the highest worldwide blood pressure (BP) levels have shifted from high-income countries to low- and middle-income countries. We investigated the association of intragenerational social mobility with changes in BP and also with the incidence of hypertension over a 4-year follow-up.
Data for 6,529 baseline participants from ELSA-Brasil born between 1938 and 1975 were used. Based on a social mobility matrix, occupational social mobility was defined as the change in occupational social class between participants' first occupation and current occupation (stable high; upward; downward; stable low). Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or use of antihypertensive medication. Hypertensive participants at baseline were excluded. Mixed effects regression models were used.
Compared to the stable high group, the downwardly mobile group showed a higher increase over time in both SBP (β = 1.49, 95% CI 0.60; 2.37) and DBP (β = 0.96, 95% CI 0.32; 1.59) after adjustments for background characteristics and also proximal risk factors such as health-related behaviors and body mass index as time-dependent covariates, and diabetes. In contrast, upward mobility had no influence on BP changes (β = 0.67, 95% CI -0.07; 1.41 for SBP, and β = 0.47, 95% CI -0.05; 1.00 for DBP). Social mobility was not associated with the incidence of hypertension.
We showed socioeconomic inequalities in BP progression over the life course. The longitudinal changes in BP varied by social mobility groups in the context of low- and middle-income countries, where high BP has become most prevalent.
在过去的 40 年中，全球最高的血压（BP）水平已从高收入国家转移到中低收入国家。我们研究了代际社会流动与 BP 变化的关系，以及在 4 年的随访期间高血压的发病率。
使用来自巴西 ELSA-Brasil 的 6529 名基线参与者的数据，这些参与者出生于 1938 年至 1975 年之间。根据社会流动矩阵，职业社会流动被定义为参与者的第一份职业和当前职业之间职业社会阶层的变化（稳定高；上升；下降；稳定低）。新发高血压定义为收缩压（SBP）≥140mmHg 或舒张压（DBP）≥90mmHg 或使用抗高血压药物。排除基线时患有高血压的参与者。使用混合效应回归模型。
与稳定高组相比，下降组在调整背景特征和健康相关行为和体重指数等近端危险因素以及糖尿病作为时间依赖性协变量后，SBP（β=1.49，95%CI 0.60；2.37）和 DBP（β=0.96，95%CI 0.32；1.59）的时间变化更高。相比之下，上升流动对 BP 变化没有影响（SBP 的β=0.67，95%CI -0.07；1.41，DBP 的β=0.47，95%CI -0.05；1.00）。社会流动与高血压的发病率无关。
我们在生命过程中显示了 BP 进展的社会经济不平等。在中低收入国家，高 BP 最为普遍的情况下，BP 的纵向变化因社会流动群体而异。
