Population Health Sciences, University of Bristol Medical School, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Population Health Sciences, University of Bristol Medical School, Bristol, UK.
Psychoneuroendocrinology. 2022 Jan;135:105577. doi: 10.1016/j.psyneuen.2021.105577. Epub 2021 Oct 28.
Associations between measures of socio-economic position and cortisol remain controversial. We examined the association between social class and cortisol reactivity in an aging male population.
The Speedwell cohort study recruited 2348 men aged 45-59 years from primary care between 1979 and 1982 (phase I) where occupational social class was used to classify socioeconomic position. Men were seen on four more occasions, the last being between 1997 and 1999 (phase 5) when salivary samples were obtained capturing cortisol reactivity to stressors (cognitive test and venepuncture) and circadian variations (awakening and night-time cortisol levels, circadian slope and area under curve) at morning and afternoon clinic sessions. Longitudinal association between social class at phase 3 and log-transformed salivary cortisol measures at phase 5 was assessed using multivariable linear regression adjusted for variables associated with sampling time and age as a potential confounder, stratified by time of clinic session. We also explored possible mediation by psychosocial factors (e.g. work dislike) and health-related factors (e.g. waist-to-hip ratio and high-density lipoprotein cholesterol).
From 1768 living men, 1003 men (57%) attended a clinic at phase five, 854 participants (85% of attendees) returned home cortisol samples (mean age 71.7 years). We found little evidence of association between social class and baseline cortisol (i.e. prior to stress), cortisol response to stressors, and cortisol diurnal variation. However, we found lower social class was associated with higher and delayed post-stress recovery cortisol for participants that visited the clinic in the morning (adjusted β coefficient for manual versus non-manual 0.25 ng/ml; 95% CI: 0.06-0.48; P = 0.008). This association did not appear to be mediated by any of the measured psychosocial or health-related factors.
Our data did not show an overall association between social class and cortisol variability either diurnal or in response to a stressor. Lower social class was associated with a slower time to recover from exposure to stress in the morning, thereby increasing overall cortisol exposure. These findings provide some evidence for a mechanism that may contribute to the association between lower social class and a higher risk of adverse health outcomes.
社会经济地位与皮质醇之间的关系仍存在争议。我们研究了老龄化男性人群中社会阶层与皮质醇反应性之间的关系。
Speedwell 队列研究于 1979 年至 1982 年期间从初级保健中招募了 2348 名 45-59 岁的男性（第 I 阶段），使用职业社会阶层来划分社会经济地位。男性在之后的四个阶段中被观察到，最后一个阶段是在 1997 年至 1999 年之间（第 5 阶段），当时采集了唾液样本，以捕捉应激源（认知测试和静脉穿刺）和昼夜节律变化（清晨和夜间皮质醇水平、昼夜节律斜率和曲线下面积）时的皮质醇反应性在上午和下午的门诊就诊期间。使用多变量线性回归评估第 3 阶段的社会阶层与第 5 阶段的唾液皮质醇测量值之间的纵向关联，调整了与采样时间和年龄相关的变量作为潜在混杂因素，并根据门诊就诊时间进行分层。我们还探索了心理社会因素（如工作厌恶）和与健康相关的因素（如腰围与臀围比和高密度脂蛋白胆固醇）的可能中介作用。
在 1768 名存活男性中，有 1003 名男性（57%）参加了第 5 阶段的门诊就诊，有 854 名参与者（就诊者的 85%）返回了家庭皮质醇样本（平均年龄为 71.7 岁）。我们几乎没有发现社会阶层与基线皮质醇（即应激前）、应激源皮质醇反应性和皮质醇昼夜变化之间存在关联。然而，我们发现，对于在上午就诊的参与者，较低的社会阶层与较高和延迟的应激后皮质醇恢复有关（手动与非手动 0.25ng/ml；95%CI：0.06-0.48；P=0.008）。这种关联似乎不是由任何测量的心理社会或与健康相关的因素介导的。
我们的数据没有显示社会阶层与昼夜皮质醇变化或应激反应之间的总体关联。较低的社会阶层与从清晨暴露于应激中恢复的时间较慢有关，从而增加了整体皮质醇暴露。这些发现为可能导致较低社会阶层与不良健康结果风险增加之间关联的机制提供了一些证据。
