Bonaccio Marialaura, Di Castelnuovo Augusto, Costanzo Simona, De Curtis Amalia, Persichillo Mariarosaria, Cerletti Chiara, Donati Maria Benedetta, de Gaetano Giovanni, Iacoviello Licia, Study Investigators On Behalf Of The Moli-Sani
Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy.
Mediterranea Cardiocentro, Napoli, Italy.
Am J Epidemiol. 2021 Feb 24. doi: 10.1093/aje/kwab046.
We investigated the association of cumulative socioeconomic disadvantage (CSD) and socioeconomic (SES) trajectories across life course with the risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) and tested some biological mechanisms in explaining such associations. Longitudinal analysis on 21,756 HF- and AF-free subjects recruited in the Moli-sani Study (2005-2010; Italy) and followed up for 8.2 years. CSD was computed using childhood SES, education and adulthood SES indicators, and the same were used to define overall trajectories. High disadvantage across life course (CSD≥8) posed subjects at increased risk of HF (Hazard ratio [HR]=2.58; 95%CI 1.78, 3.74) or AF (HR=1.57;1.05,2.33), as compared to low CSD. All explanatory factors accounted for 18.5% and 24% of the excess of HF and AF risks, respectively, associated with CSD. For subjects with low childhood SES, advancements in education lowered risk of HF (HR=0.70;0.48, 1.02) or AF (HR=0.50;0.28, 0.89), whereas achievements of adulthood SES were unlikely to contribute to disease reduction. In conclusion, a life-course disadvantaged SES is an important predictor of first hospitalization for HF and AF; known risk factors partially explained the SES-disease gradient. Upwardly mobile groups are likely to mitigate the effect of poor childhood circumstances especially through educational advancement.
我们调查了累积社会经济劣势（CSD）以及生命历程中的社会经济（SES）轨迹与首次因心力衰竭（HF）或心房颤动（AF）住院风险之间的关联，并测试了一些生物学机制来解释这种关联。对莫利萨尼研究（2005 - 2010年；意大利）招募的21756名无HF和AF的受试者进行纵向分析，并随访8.2年。使用儿童期SES、教育程度和成年期SES指标计算CSD，并使用相同指标定义总体轨迹。与低CSD相比，生命历程中高劣势（CSD≥8）使受试者患HF（风险比[HR]=2.58；95%置信区间1.78, 3.74）或AF（HR=1.57；1.05, 2.33）的风险增加。所有解释因素分别占与CSD相关的HF和AF风险超额部分的18.5%和24%。对于儿童期SES低的受试者，教育程度提高可降低患HF（HR=0.70；0.48, 1.02）或AF（HR=0.50；0.28, 0.89）的风险，而成年期SES的成就不太可能有助于降低疾病风险。总之，生命历程中处于劣势的SES是首次因HF和AF住院的重要预测因素；已知风险因素部分解释了SES - 疾病梯度。向上流动的群体可能会减轻儿童期不良环境的影响，尤其是通过教育进步。
