Department of Cardiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, China.
Department of Cardiology, Hospital of Traditional Chinese Medicine, Shuangliu District, Chengdu, China.
J Epidemiol Glob Health. 2023 Jun;13(2):322-332. doi: 10.1007/s44197-023-00095-3. Epub 2023 Mar 4.
Whether healthy lifestyles mediate the association of socioeconomic status (SES) with mortality in older people is largely unknown.
A total of 22,093 older participants (age ≥ 65 years) from 5 waves (2002-2014) of Chinese Longitudinal Healthy Longevity Survey cohort were included for analysis. Mediation analysis of lifestyles on the association of SES with all-cause mortality was conducted.
During a mean follow-up period of 4.92 ± 4.03 years, 15,721 (71.76%) deaths occurred. Compared with high SES, medium SES increased the risk of mortality by 13.5% (HR [total effect]: 1.135, 95% CI 1.067-1.205, p < 0.001), and the total effect was not mediated by healthy lifestyles (mediation proportion: - 0.1%, 95% CI - 3.8 to 3.3%, p = 0.936). The total effect when participants of low SES were compared with participants of high SES was HR = 1.161 (95% CI 1.088-1.229, p < 0.001) for mortality, and the total effect was modestly mediated through healthy lifestyles (mediation proportion: - 8.9%, 95% CI - 16.6 to - 5.1%, p < 0.001). Stratification analyses by sex, age and comorbidities, as well as a series of sensitivity analyses indicated similar results. In addition, mortality risk showed a downward trend with increased number of healthy lifestyles within each SES level (all p for trend < 0.050).
Promotion of healthy lifestyles alone can only reduce a small proportion of socioeconomic inequity-related mortality risk in older Chinese people. Even so, healthy lifestyles are important in reducing the overall mortality risk within each SES level.
健康生活方式是否能调节社会经济地位（SES）与老年人死亡率之间的关联，目前还知之甚少。
本研究共纳入了来自中国长寿纵向研究（CLHLS）5 个波次（2002-2014 年）的 22093 名年龄≥65 岁的老年人。采用中介分析方法探讨生活方式在 SES 与全因死亡率之间的关联中的作用。
在平均 4.92±4.03 年的随访期间，共发生 15721 例死亡（71.76%）。与高 SES 相比，中 SES 使死亡风险增加了 13.5%（总效应 HR：1.135，95%CI：1.067-1.205，p<0.001），且健康生活方式并未介导这一总效应（中介比例：-0.1%，95%CI：-3.8 至 3.3%，p=0.936）。与高 SES 相比，低 SES 使死亡风险增加了 HR=1.161（95%CI：1.088-1.229，p<0.001），健康生活方式对这一总效应的介导作用较小（中介比例：-8.9%，95%CI：-16.6 至-5.1%，p<0.001）。按性别、年龄和合并症进行分层分析以及一系列敏感性分析均得到了相似的结果。此外，在每个 SES 水平内，健康生活方式的数量增加与死亡率呈下降趋势（所有 p 趋势值<0.050）。
仅促进健康的生活方式只能降低中国老年人中一小部分与社会经济不平等相关的死亡风险。即便如此，健康的生活方式对于降低每个 SES 水平内的总体死亡风险仍然很重要。
