Zeng Qingping, Liao Mengqian, Li Yu, She Fei, Zhang Ping
Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), School of Clinical Medicine, Tsinghua University, Beijing, China.
PLoS One. 2025 Aug 22;20(8):e0328924. doi: 10.1371/journal.pone.0328924. eCollection 2025.
The relationship between socioeconomic status and cardiovascular disease among the general Chinese population is inconclusive.
This study aims to investigate the relationship between socioeconomic status and cardiovascular disease in the Chinese general population through a large sample.
We retrospectively analyzed data from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Participants were required to be at least 45 years old and have cardiovascular disease (CVD) data. The study was divided into two parts: a cross-sectional analysis using 2015 data, and a longitudinal analysis of participants without CVD in 2015 but with complete follow-up data in 2018. Socioeconomic status (SES) was assessed using self-reported household income, occupation, education level, and health insurance. CVD events were identified through participant-reported diagnoses of heart disease or stroke. Logistic and Cox proportional hazards regression models were used to estimate the association between SES and CVD.
16,560 participants were included in the cross-sectional analysis and 11,587 in the longitudinal analysis.
Socioeconomic status.
Cardiovascular disease, heart disease, and stroke.
In the cross-sectional analysis, 16% of the 16,560 participants had CVD, with higher prevalence in lower SES groups. After adjustments, middle SES was significantly associated with increased CVD risk (OR 1.77, 95% CI 1.21-2.58). In the longitudinal analysis, during a 3-year follow-up, 12.1% of 11,587 participants developed CVD. Middle SES was associated with a 67% higher risk of new-onset CVD (HR 1.67, 95% CI 1.02-2.74). Sensitivity analysis confirmed these findings, with middle SES showing a significant association with CVD risk (HR 1.32, 95% CI 1.04-1.67).
In the general population of China, middle socioeconomic status is positively associated with cardiovascular disease and is more likely to be associated with new-onset cardiovascular disease. Our findings support the need for trade-offs between socioeconomic status groups to benefit different populations, especially considering the middle socioeconomic status group, which is an easily overlooked group. However, more long-term prospective studies are needed to further elucidate the relationship between changes in socioeconomic status and cardiovascular disease in China.
在中国普通人群中，社会经济地位与心血管疾病之间的关系尚无定论。
本研究旨在通过大样本调查中国普通人群中社会经济地位与心血管疾病之间的关系。
我们回顾性分析了中国健康与养老追踪调查（CHARLS）2015年和2018年两轮的数据。参与者需年满45岁且有心血管疾病（CVD）数据。该研究分为两部分：使用2015年数据进行横断面分析，以及对2015年无CVD但2018年有完整随访数据的参与者进行纵向分析。社会经济地位（SES）通过自我报告的家庭收入、职业、教育水平和医疗保险来评估。CVD事件通过参与者报告的心脏病或中风诊断来确定。使用逻辑回归和Cox比例风险回归模型来估计SES与CVD之间的关联。
横断面分析纳入了16560名参与者，纵向分析纳入了11587名参与者。
社会经济地位。
心血管疾病、心脏病和中风。
在横断面分析中，16560名参与者中有16%患有CVD，社会经济地位较低的群体患病率更高。调整后，中等社会经济地位与CVD风险增加显著相关（比值比1.77，95%置信区间1.21 - 2.58）。在纵向分析中，在3年的随访期间，11587名参与者中有12.1%患上了CVD。中等社会经济地位与新发CVD风险高67%相关（风险比1.67，95%置信区间1.02 - 2.74）。敏感性分析证实了这些发现，中等社会经济地位与CVD风险显著相关（风险比1.32，95%置信区间1.04 - 1.67）。
在中国普通人群中，中等社会经济地位与心血管疾病呈正相关，且更有可能与新发心血管疾病相关。我们的研究结果支持在社会经济地位群体之间进行权衡以惠及不同人群的必要性，特别是考虑到中等社会经济地位群体，这是一个容易被忽视的群体。然而，需要更多的长期前瞻性研究来进一步阐明中国社会经济地位变化与心血管疾病之间的关系。
