Casper M L, Barnett E B, Armstrong D L, Giles W H, Blanton C J
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Ann Epidemiol. 1997 Feb;7(2):146-53. doi: 10.1016/s1047-2797(96)00113-5.
The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.
这项研究的目的是检验黑人和白人社会阶层与过早中风死亡率之间的关联。对于北卡罗来纳州年龄在35 - 54岁的黑人男性和白人男性，将1984 - 1993年生命统计档案中的死亡率数据与人口普查公共使用微观数据样本档案中的人口数据按社会阶层进行匹配。基于职业的二维分类方案定义了四类社会阶层。对于每一类社会阶层，计算了种族特异性年龄调整后的中风死亡率，并估计了种族特异性的收入、财富、教育、失业和残疾患病率。由于死亡率和人口数据源没有提供关于社会阶层的可比信息，所以排除了女性。对于黑人男性和白人男性，在社会阶层最低的人群中观察到过早中风死亡率最高。社会阶层最低与最高之间的率比（RR），黑人男性为2.8，白人男性为2.3。在每一个社会阶层中，黑人男性过早中风死亡率显著高于白人男性（黑人与白人的RR范围为4.0至4.9）。在黑人男性和白人男性中，社会阶层最高的人群在收入、财富、教育和就业方面始终具有最有利的水平。黑人男性和白人男性社会阶层与中风死亡率之间的负相关关系支持了开展中风预防工作的必要性，这些工作应解决经济和社会状况中的结构性不平等问题。
