美国队列研究中收入波动与心血管疾病事件和全因死亡率的关系。
Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort.
机构信息
Department of Public Health Sciences, School of Medicine (T.E., S.L.S., A.Z.A.H.), University of Miami, FL.
Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
出版信息
Circulation. 2019 Feb 12;139(7):850-859. doi: 10.1161/CIRCULATIONAHA.118.035521.
BACKGROUND
Income volatility is on the rise and presents a growing public health problem. Because in many epidemiological studies income is measured at a single point in time, the association of long-term income volatility with incident cardiovascular disease (CVD) and mortality has not been adequately explored. The goal of this study was to examine associations of income volatility from 1990 to 2005 with incident CVD and all-cause mortality in the subsequent 10 years.
METHODS
The Coronary Artery Risk Development in Young Adults Study is an ongoing prospective cohort study conducted within urban field centers in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. We studied 3937 black and white participants 23 to 35 years of age in 1990 (our study baseline). Income volatility was defined as the intraindividual SD of the percent change in income across 5 assessments from 1990 to 2005. An income drop was defined as a decrease of ≥25% from the previous visit and less than the participant's average income from 1990 to 2005. CVD events (fatal and nonfatal) and all-cause mortality between 2005 and 2015 were adjudicated with the use of medical records and death certificates. CVD included primarily acute events related to heart disease and stroke.
RESULTS
A total of 106 CVD events and 164 deaths occurred between 2005 and 2015 (incident rate, 2.76 and 3.66 per 1000 person-years, respectively). From Cox models adjusted for sociodemographic, behavioral, and CVD risk factors, higher income volatility and more income drops were associated with greater CVD risk (high versus low volatility: hazard ratio, 2.07; 95% CI, 1.10-3.90; ≥2 versus 0 income drops: hazard ratio, 2.54; 95% CI, 1.24-5.19) and all-cause mortality (high versus low volatility: hazard ratio, 1.78; 95% CI,1.03-3.09; ≥2 versus 0 income drops: hazard ratio, 1.92; 95% CI, 1.07-3.44).
CONCLUSIONS
In a cohort of relatively young adults, income volatility and drops during a 15-year period of formative earning years were independently associated with a nearly 2-fold risk of CVD and all-cause mortality.
背景
收入波动正在上升，这是一个日益严重的公共卫生问题。由于在许多流行病学研究中，收入是在一个时间点上测量的，因此长期收入波动与心血管疾病（CVD）和死亡率的关系尚未得到充分探讨。本研究的目的是探讨 1990 年至 2005 年期间收入波动与随后 10 年内 CVD 发生率和全因死亡率的关系。
方法
冠状动脉风险发展在年轻人研究是一个正在进行的前瞻性队列研究，在伯明翰，AL；芝加哥，IL；明尼阿波利斯，MN；和奥克兰，CA 的城市现场中心进行。我们研究了 1990 年（我们的研究基线）时年龄在 23 至 35 岁之间的 3937 名黑人和白人参与者。收入波动定义为 1990 年至 2005 年期间收入变化的个体内标准差的 5 次评估。收入下降定义为下降≥25%从上次就诊时，低于参与者 1990 年至 2005 年的平均收入。2005 年至 2015 年期间，使用医疗记录和死亡证明对 CVD 事件（致死和非致死）和全因死亡率进行了裁决。CVD 包括主要与心脏病和中风有关的急性事件。
结果
在 2005 年至 2015 年期间，共发生 106 例 CVD 事件和 164 例死亡（发病率分别为每 1000 人年 2.76 和 3.66）。从调整社会人口统计学、行为和 CVD 风险因素的 Cox 模型中可以看出，较高的收入波动和更多的收入下降与更高的 CVD 风险（高波动与低波动相比：风险比，2.07；95%置信区间，1.10-3.90；≥2 次与 0 次收入下降相比：风险比，2.54；95%置信区间，1.24-5.19）和全因死亡率（高波动与低波动相比：风险比，1.78；95%置信区间，1.03-3.09；≥2 次与 0 次收入下降相比：风险比，1.92；95%置信区间，1.07-3.44）。
结论
在一个相对年轻的成年人队列中，在形成收入的 15 年期间，收入波动和下降与 CVD 和全因死亡率增加近 2 倍的风险独立相关。
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