Lynch J W, Kaplan G A, Cohen R D, Kauhanen J, Wilson T W, Smith N L, Salonen J T
Human Population Laboratory, California Department of Community Health Services, Berkeley 94704.
Lancet. 1994 Feb 26;343(8896):524-7. doi: 10.1016/s0140-6736(94)91468-0.
Research has suggested that social-class differences in adult health may be at least partly determined by conditions earlier in life. In 2636 Finnish men, we assessed impact of childhood and adult socioeconomic conditions on adult mortality risk by examining whether differing socioeconomic life-courses from early childhood to adulthood were associated with different risks of all-cause and cardiovascular mortality. Compared with high-income adults, those with low income had increased relative risks of all-cause (2.54, 95% CI 1.83-3.53) and cardiovascular (2.37, 1.51-3.7) mortality, but these increased risks were not related in either adult group to childhood socioeconomic conditions. Men who went from low-income childhood to high-income adulthood had the same mortality risks as those whose socioeconomic circumstances were good in both childhood and adulthood (1.14, 0.56-2.31, all causes; 0.99, 0.39-2.51, cardiovascular). By contrast, men who experienced poor socioeconomic circumstances as both children and adults were about twice as likely to die as those whose position improved (2.39, 1.28-4.44, all causes; 2.02, 0.9-4.54, cardiovascular). Our findings suggest that socioeconomic conditions in childhood are not important determinants of adult health. We caution against this interpretation--a life-course approach to socioeconomic differences in adult health requires understanding of the social and economic context in which individual life-courses are determined.
研究表明，成人健康方面的社会阶层差异可能至少部分由生命早期的状况所决定。在2636名芬兰男性中，我们通过研究从幼儿期到成年期不同的社会经济生活轨迹是否与全因死亡率和心血管死亡率的不同风险相关，来评估儿童期和成年期社会经济状况对成人死亡风险的影响。与高收入成年人相比，低收入成年人的全因死亡率（2.54，95%可信区间1.83 - 3.53）和心血管死亡率（2.37，1.51 - 3.7）的相对风险增加，但在这两个成年人群组中，这些增加的风险与儿童期社会经济状况均无关联。从低收入儿童期步入高收入成年期的男性与在儿童期和成年期社会经济状况都良好的男性具有相同的死亡风险（全因死亡率为1.14，0.56 - 2.31；心血管死亡率为0.99，0.39 - 2.51）。相比之下，在儿童期和成年期都经历不良社会经济状况的男性死亡可能性约为那些状况得到改善的男性的两倍（全因死亡率为2.39，1.28 - 4.44；心血管死亡率为2.02，0.9 - 4.54）。我们的研究结果表明，儿童期的社会经济状况并非成人健康的重要决定因素。我们提醒不要这样解读——采用生命历程方法研究成人健康方面的社会经济差异需要理解个体生命历程所确定的社会和经济背景。
