Vth Department of Medicine (Nephrology Hypertensiology, Rheumatology, Endocrinology, Diabetology) Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria.
Clin Res Cardiol. 2020 Jan;109(1):103-114. doi: 10.1007/s00392-019-01494-y. Epub 2019 May 29.
Low individual socioeconomic status (SES) is a known risk factor for morbidity and mortality. A related measure is the area-based SES (abSES), which describes the average SES of a region. The association of measures of abSES with morbidity and mortality is less well studied.
The Ludwigshafen Risk and Cardiovascular Health study consists of 3316 patients hospitalized for coronary angiography between 1997 and 2000 at a tertiary care centre in Germany. Patients were followed up for a median of 10 years. Two measures of abSES were used: the regional purchasing index (PPI, data obtained from IQVIA GmbH) and the German Index of Socioeconomic Deprivation (GISD, developed by the Robert-Koch Institute). The association of abSES with disease and with mortality was analysed using logistic regression and Cox proportional hazards regression, respectively.
Study participants living in regions with higher abSES had lower HbA1c and high-sensitive C-reactive protein. A higher abSES was associated with lower prevalence of active smoking, vitamin D deficiency and diabetes mellitus. We further found significantly increased mortality for participants in the lowest PPI quartile (age- and sex-adjusted hazard ratio (95% CI) of 0.58 (0.38-0.90) as compared to the first quartile), and in the highest GISD tertile (HR of 1.32 (1.13-1.54) as compared to the first tertile).
Living in an area with a low abSES was associated with a higher burden of diabetes mellitus, a higher percentage of severe vitamin D deficiency, higher systemic inflammation and a significant increase in mortality.
低个体社会经济地位（SES）是发病率和死亡率的已知危险因素。相关的衡量标准是基于区域的 SES（abSES），它描述了一个地区的平均 SES。abSES 与发病率和死亡率的关联研究较少。
Ludwigshafen 风险和心血管健康研究包括 1997 年至 2000 年期间在德国一家三级保健中心因冠状动脉造影住院的 3316 名患者。患者的中位随访时间为 10 年。使用了两种 abSES 衡量标准：区域购买力指数（PPI，从 IQVIA GmbH 获取的数据）和德国社会经济剥夺指数（GISD，由罗伯特·科赫研究所开发）。使用逻辑回归和 Cox 比例风险回归分别分析 abSES 与疾病和死亡率的关系。
居住在 abSES 较高地区的研究参与者的糖化血红蛋白和高敏 C 反应蛋白较低。较高的 abSES 与较低的吸烟率、维生素 D 缺乏症和糖尿病患病率相关。我们还发现，处于最低 PPI 四分位的参与者的死亡率显著增加（年龄和性别调整后的危险比（95%CI）为 0.58（0.38-0.90），与第一四分位相比），而处于最高 GISD 三分位的参与者的死亡率显著增加（HR 为 1.32（1.13-1.54），与第一三分位相比）。
生活在 abSES 较低的地区与糖尿病负担较高、严重维生素 D 缺乏症的比例较高、全身炎症水平较高以及死亡率显著增加有关。
