Department of Epidemiology-Data-Biostatistics, Foch Hospital, Suresnes, 92150, France.
Public Health. 2023 Aug;221:1-9. doi: 10.1016/j.puhe.2023.05.014. Epub 2023 Jun 16.
The association between cardiovascular disease (CVD) risk and socio-economic status (SES) remains poorly studied. The purpose of this study was to investigate the relationship between SES and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among the general UK Biobank population.
This was a population-based study.
Among 311,928 volunteers (47.7% men) of the UK Biobank population, SES was assessed by a questionnaire, and ASCVD risk was calculated using pooled cohort equation models. Associations between SES and ASCVD risk were estimated using multiple gender-specific regressions.
The findings from this study showed that men had higher estimated 10-year ASCVD risk than women (8.6% vs 2.7%; P < 0.001), higher education level (38.3% vs 36.2%; P < 0.001), higher income level (31.0% vs 25.1%; P < 0.001), higher levels of employment (65.4% vs 60.5%; P < 0.001) and higher scores of Townsend deprivation (P < 0.001). Using the multiple logistic regression model, a decreased 10-year ASCVD risk in men was associated with high income level (odds ratio [OR] = 0.64 [95% confidence interval {CI} 0.61-0.68]; P < 0.001), high educational level (OR = 0.71 [95% CI 0.68-0.74]; P < 0.001), higher Townsend deprivation quintile (OR = 0.81 [95% CI 0.78-0.85]; P < 0.001) and employed status (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001). The same results were observed in women, with high income level (OR = 0.68 [95% CI 0.55-0.68]; P < 0.001), high educational level (OR = 0.87 [95% CI 0.82-0.93]; P < 0.001), higher Townsend deprivation quintile (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001) and employed status (OR = 0.53 [95% CI 0.45-0.63]; P < 0.001) being associated with a lower 10-year ASCVD risk. When considering the false discovery rate logworth analysis, SES factors presented a similar contribution to CVD risk as lifestyle factors.
Health policies should consider the SES factors identified in this study, in addition to traditional risk factors, when designing prevention campaigns for CVD. Further research is required to improve the ASCVD risk prediction models among different SES variables.
心血管疾病（CVD）风险与社会经济地位（SES）之间的关联仍研究不足。本研究旨在调查英国生物银行人群中 SES 与估计的 10 年动脉粥样硬化性心血管疾病（ASCVD）风险之间的关系。
这是一项基于人群的研究。
在英国生物银行的 311928 名志愿者（47.7%为男性）中，通过问卷评估 SES，使用汇总队列方程模型计算 ASCVD 风险。使用多个性别特异性回归估计 SES 与 ASCVD 风险之间的关联。
研究结果表明，男性的估计 10 年 ASCVD 风险高于女性（8.6%对 2.7%；P<0.001），受教育程度更高（38.3%对 36.2%；P<0.001），收入水平更高（31.0%对 25.1%；P<0.001），就业率更高（65.4%对 60.5%；P<0.001），城镇贫困程度更高（P<0.001）。使用多因素逻辑回归模型，男性 ASCVD 风险降低与高收入水平（比值比[OR] = 0.64[95%置信区间{CI} 0.61-0.68]；P<0.001）、高教育水平（OR = 0.71[95%CI 0.68-0.74]；P<0.001）、较高的城镇贫困五分位数（OR = 0.81[95%CI 0.78-0.85]；P<0.001）和就业状态（OR = 0.74[95%CI 0.69-0.80]；P<0.001）有关。在女性中也观察到相同的结果，高收入水平（OR = 0.68[95%CI 0.55-0.68]；P<0.001）、高教育水平（OR = 0.87[95%CI 0.82-0.93]；P<0.001）、较高的城镇贫困五分位数（OR = 0.74[95%CI 0.69-0.80]；P<0.001）和就业状态（OR = 0.53[95%CI 0.45-0.63]；P<0.001）与较低的 10 年 ASCVD 风险相关。当考虑虚假发现率对数似然分析时，SES 因素与生活方式因素一样，对 CVD 风险有相似的贡献。
在制定 CVD 预防活动的健康政策时，除了传统的危险因素外，还应考虑本研究中确定的 SES 因素。需要进一步研究以改善不同 SES 变量的 ASCVD 风险预测模型。
