社会经济地位与成年期身心健康状况发展的关联：一项多队列研究。

Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study.

机构信息

Department of Epidemiology and Public Health, University College London, London, UK.

Department of Epidemiology and Public Health, University College London, London, UK; School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA.

出版信息

Lancet Public Health. 2020 Mar;5(3):e140-e149. doi: 10.1016/S2468-2667(19)30248-8. Epub 2020 Jan 31.

DOI:10.1016/S2468-2667(19)30248-8

PMID:32007134

Abstract

BACKGROUND

Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status and temporal sequences in the development of 56 common diseases and health conditions.

METHODS

In this multi-cohort study, we used data from two Finnish prospective cohort studies: the Health and Social Support study and the Finnish Public Sector study. Our pooled prospective primary analysis data comprised 109 246 Finnish adults aged 17-77 years at study entry. We captured socioeconomic status using area deprivation and education at baseline (1998-2013). Participants were followed up for health conditions diagnosed according to the WHO International Classification of Diseases until 2016 using linkage to national health records. We tested the generalisability of our findings with an independent UK cohort study-the Whitehall II study (9838 people, baseline in 1997, follow-up to 2017)-using a further socioeconomic status indicator, occupational position.

FINDINGS

During 1 110 831 person-years at risk, we recorded 245 573 hospitalisations in the Finnish cohorts; the corresponding numbers in the UK study were 60 946 hospitalisations in 186 572 person-years. Across the three socioeconomic position indicators and after adjustment for lifestyle factors, compared with more advantaged groups, low socioeconomic status was associated with increased risk for 18 (32·1%) of the 56 conditions. 16 diseases formed a cascade of inter-related health conditions with a hazard ratio greater than 5. This sequence began with psychiatric disorders, substance abuse, and self-harm, which were associated with later liver and renal diseases, ischaemic heart disease, cerebral infarction, chronic obstructive bronchitis, lung cancer, and dementia.

INTERPRETATION

Our findings highlight the importance of mental health and behavioural problems in setting in motion the development of a range of socioeconomically patterned physical illnesses. Policy and health-care practice addressing psychological health issues in social context and early in the life course could be effective strategies for reducing health inequalities.

FUNDING

UK Medical Research Council, US National Institute on Aging, NordForsk, British Heart Foundation, Academy of Finland, and Helsinki Institute of Life Science.

摘要

背景

社会经济劣势是许多疾病的一个风险因素。我们通过使用数据驱动的方法来描述这些情况的级联，以检查社会经济地位与 56 种常见疾病和健康状况发展之间的时间序列之间的关联。

方法

在这项多队列研究中，我们使用了两项芬兰前瞻性队列研究的数据：健康和社会支持研究以及芬兰公共部门研究。我们的合并前瞻性主要分析数据包括 109246 名年龄在 17-77 岁的芬兰成年人，在研究开始时接受了调查。我们在基线（1998-2013 年）使用区域贫困和教育来衡量社会经济地位。参与者根据世界卫生组织国际疾病分类标准，通过与国家健康记录的链接，在 2016 年之前接受了所诊断出的健康状况的随访。我们使用另一项社会经济地位指标——职业地位，通过英国独立队列研究——白厅 II 研究（9838 人，基线在 1997 年，随访至 2017 年），对我们的发现进行了可推广性检验。

结果

在 1110831 人年的风险期内，我们在芬兰队列中记录了 245573 例住院治疗；在英国研究中，相应的数字为 186572 人年中的 60946 例住院治疗。在三个社会经济地位指标中，并且在调整了生活方式因素后，与更有利的群体相比，较低的社会经济地位与 18 种（32.1%）56 种疾病的风险增加有关。16 种疾病形成了一连串相互关联的健康状况，其危险比大于 5。该序列始于精神疾病、药物滥用和自残，随后是肝脏和肾脏疾病、缺血性心脏病、脑梗死、慢性阻塞性支气管病、肺癌和痴呆。