社会剥夺对心血管代谢性多病症发病率和全因死亡率的影响：英国生物库队列的队列分析。

Influence of social deprivation on morbidity and all-cause mortality of cardiometabolic multi-morbidity: a cohort analysis of the UK Biobank cohort.

机构信息

Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.

Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.

出版信息

BMC Public Health. 2023 Nov 7;23(1):2177. doi: 10.1186/s12889-023-17008-5.

DOI:10.1186/s12889-023-17008-5

PMID:37932741

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10629082/

Abstract

BACKGROUND

The relation of social deprivation with single cardiometabolic disease (CMD) was widely investigated, whereas the association with cardiometabolic multi-morbidity (CMM), defined as experiencing more than two CMDs during the lifetime, is poorly understood.

METHODS

We analyzed 345,417 UK Biobank participants without any CMDs at recruitment to study the relation between social deprivation and four CMDs including type II diabetes (T2D), coronary artery disease (CAD), stroke and hypertension. Social deprivation was measured by Townsend deprivation index (TDI), and CMM was defined as occurrence of two or more of the above four diseases. Multivariable Cox models were performed to estimate hazard ratios (HRs) per one standard deviation (SD) change and in quartile (Q1-Q4, with Q1 as reference), as well as 95% confidence intervals (95% CIs).

RESULTS

During the follow up, 68,338 participants developed at least one CMD (median follow up of 13.2 years), 16,225 further developed CMM (median follow up of 13.4 years), and 18,876 ultimately died from all causes (median follow up of 13.4 years). Compared to Q1 of TDI (lowest deprivation), the multivariable adjusted HR (95%CIs) of Q4 (highest deprivation) among participants free of any CMDs was 1.23 (1.20 ~ 1.26) for developing one CMD, 1.42 (1.35 ~ 1.48) for developing CMM, and 1.34 (1.27 ~ 1.41) for all-cause mortality. Among participants with one CMD, the adjusted HR (95%CIs) of Q4 was 1.30 (1.27 ~ 1.33) for developing CMM and 1.34 (1.27 ~ 1.41) for all-cause mortality, with HR (95%CIs) = 1.11 (1.06 ~ 1.16) for T2D patients, 1.07 (1.03 ~ 1.11) for CAD patients, 1.07 (1.00 ~ 1.15) for stroke patients, and 1.24 (1.21 ~ 1.28) for hypertension patients. Among participants with CMM, TDI was also related to the risk of all-cause mortality (HR of Q4 = 1.35, 95%CIs 1.28 ~ 1.43).

CONCLUSIONS

We revealed that people living with high deprived conditions would suffer from higher hazard of CMD, CMM and all-cause mortality.

摘要

背景

社会剥夺与单一心血管代谢疾病（CMD）的关系已得到广泛研究，而与心血管代谢多疾病（CMM）的关系则知之甚少，CMM 定义为一生中经历两种或两种以上 CMD。

方法

我们分析了 345417 名在招募时没有任何 CMD 的英国生物银行参与者，以研究社会剥夺与四种 CMD 之间的关系，包括 2 型糖尿病（T2D）、冠心病（CAD）、中风和高血压。社会剥夺程度由汤森剥夺指数（TDI）衡量，CMM 定义为上述四种疾病中的两种或两种以上疾病的发生。采用多变量 Cox 模型估计每标准差（SD）变化的危险比（HR）和四分位（Q1-Q4，Q1 为参考）以及 95%置信区间（95%CI）。

结果

在随访期间，68338 名参与者至少发生了一种 CMD（中位随访 13.2 年），16225 名参与者进一步发生了 CMM（中位随访 13.4 年），18876 名参与者最终因各种原因死亡（中位随访 13.4 年）。与 TDI 的 Q1（最低剥夺）相比，无任何 CMD 的参与者中，Q4（最高剥夺）的多变量调整 HR（95%CI）分别为 1.23（1.20~~1.26）用于发展为一种 CMD，1.42（1.35~~1.48）用于发展 CMM，1.34（1.27~~1.41）用于全因死亡率。在患有一种 CMD 的参与者中，Q4 的调整 HR（95%CI）为 1.30（1.27~~1.33）用于发展 CMM 和 1.34（1.27~~1.41）用于全因死亡率，T2D 患者的 HR（95%CI）为 1.11（1.06~~1.16），CAD 患者为 1.07（1.03~~1.11），中风患者为 1.07（1.00~~1.15），高血压患者为 1.24（1.21~~1.28）。在患有 CMM 的参与者中，TDI 也与全因死亡率的风险相关（Q4 的 HR=1.35，95%CI 为 1.28~~1.43）。