父亲的社会阶层对中年男性心血管疾病的影响。

Influence of fathers' social class on cardiovascular disease in middle-aged men.

作者信息

Wannamethee S G, Whincup P H, Shaper G, Walker M

机构信息

Department of Primary Care and Population Science, Royal Free Hospital School of Medicine, London, UK.

出版信息

Lancet. 1996 Nov 9;348(9037):1259-63. doi: 10.1016/S0140-6736(96)02465-8.

DOI:10.1016/S0140-6736(96)02465-8

PMID:8909377

Abstract

BACKGROUND

The independent effect of early life circumstances on adult cardiovascular risk is still unresolved. We assessed the associations of father's social class with cardiovascular risk factors and with risk of ischaemic heart disease and stroke in adult life.

METHODS

We did a longitudinal study of cardiovascular disease in 5934 men aged 40-59 years at enrollment. A cross-sectional measurement survey was done between 1978 and 1980 and a follow-up questionnaire was completed in 1992. The main endpoints were non-fatal myocardial infarction and stroke based on general practitioners' reports obtained between screening and 1992 and on recall of physician-diagnosed ischaemic heart disease in the 1992 questionnaire.

FINDINGS

Father's social class was strongly associated with social class in adulthood (fathers' occupation was manual for 41.3% of professionals [I] vs 89.1% for unskilled manual workers [V]) and was significantly related to height (non-manual vs manual 175.4 cm [SE 0.2] vs 172.9 cm [0.1], p < 0.0001) and obesity (213 [14.1%] vs 804 [20.1%], p < 0.0001) irrespective of adult social class; no association was found with blood glucose (log, 1.69 [0.005] vs 1.70 [0.003], p = 0.22) or cholesterol (6.34 [0.03] vs 6.29 mmol/L [0.02], p = 0.16. Men whose fathers' social class was manual had significantly higher rates of non-fatal myocardial infarction (342/4006 vs 92/1510) and self-reported physician-diagnosed ischaemic heart disease (686/4006 vs 192/1510) than men whose fathers' social class was non-manual, even after adjustment for adult social class and other established risk factors (relative odds 1.3 [95% Cl 1.0-1.7], p < 0.05 and 1.3 [1.1-1.6], p < 0.01, respectively). The influence of father's social class on non-fatal myocardial infarction and ischaemic heart disease was only seen in men whose adult social class was non-manual. No association was seen between father's social class and non-fatal stroke.

INTERPRETATION

Father's social class is strongly associated with adult social class. The higher risk of non-fatal myocardial infarction and self-reported physician-diagnosed ischaemic heart disease seen in men whose father's social class was manual suggests that socioeconomic status early in life has some persisting influence on ischaemic heart disease risk in adult life.

摘要

背景

早年生活环境对成年人心血管疾病风险的独立影响仍未明确。我们评估了父亲的社会阶层与心血管疾病风险因素以及成年后缺血性心脏病和中风风险之间的关联。

方法

我们对5934名年龄在40 - 59岁之间的男性进行了一项心血管疾病纵向研究。在1978年至1980年间进行了横断面测量调查，并于1992年完成了一份随访问卷。主要终点是基于1992年筛查至1992年期间全科医生报告以及1992年问卷中对医生诊断的缺血性心脏病的回忆所确定的非致命性心肌梗死和中风。

研究结果

父亲的社会阶层与成年后的社会阶层密切相关（专业人员中父亲职业为体力劳动者的占41.3% [I]，而非技术体力劳动者中这一比例为89.1% [V]），并且与身高显著相关（非体力劳动者与体力劳动者相比，分别为175.4厘米[标准误0.2]和172.9厘米[0.1]，p < 0.0001）以及肥胖（分别为213例[14.1%]和804例[20.1%]，p < 0.0001），与成年后的社会阶层无关；未发现与血糖（对数，1.69 [0.005] 与1.70 [0.003]，p = 0.22）或胆固醇（6.34 [0.03] 与6.29毫摩尔/升[0.02]，p = 0.16）有关联。父亲社会阶层为体力劳动者的男性发生非致命性心肌梗死（342/4006与92/1510）和自我报告的医生诊断的缺血性心脏病（686/4006与192/1510）的发生率显著高于父亲社会阶层为非体力劳动者的男性，即使在对成年社会阶层和其他既定风险因素进行调整后（相对比值分别为1.3 [95%可信区间1.0 - 1.7]，p < 0.05和1.3 [1.1 - 1.6]，p < 0.01）。父亲社会阶层对非致命性心肌梗死和缺血性心脏病的影响仅在成年社会阶层为非体力劳动者的男性中可见。未发现父亲社会阶层与非致命性中风之间存在关联。