Wannamethee S G, Shaper A G
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Int J Epidemiol. 1997 Jun;26(3):532-41. doi: 10.1093/ije/26.3.532.
It has been suggested that mortality differences between groups in society may be greater than are indicated by social class based on occupation. We have examined the relationship between social class and mortality using home and car ownership as additional indices of socioeconomic status within social class.
A prospective study of a cohort of men representative of the social class distribution of middle-aged men in Great Britain.
One general practice in each of 24 towns in England, Wales and Scotland.
Five years after the initial screening of 7735 men aged 40-59 years, 7262 men (94% of the original cohort) provided information on housing tenure and car ownership by completing a postal questionnaire.
Deaths from all causes, cardiovascular, cancer and other non-cardiovascular causes during an average follow-up of 9.8 years (range 8.5-11.0 years) after the postal questionnaire.
During the follow-up period there were 946 deaths from all causes among the 7262 men. The lowest mortality rates for all causes, cardiovascular, cancer and other non-cardiovascular causes were seen in non-manual social classes I and II. Manual social classes III and IV+V showed a significant 40% increase in risk of death compared to social classes I+II, even after adjustment for a wide range of risk factors (relative risk [RR] = 1.4, 95% confidence interval [CI]: 1.2-1.7 and RR = 1.4, 95% CI: 1.1-1.7 respectively). Within all social class groups, those owning both home and car showed lower rates than those who owned neither, even after adjustment for a wide range of risk factors and employment status. Compared with social classes I+II owning both home and car, all those not owning home and/or car, in each social group, showed a significant approximately twofold increase in risk of death. Adjusted RR for non-manual I+II = 2.1 (95% CI: 1.5-2.9), non-manual III RR = 2.0 (95% CI: 1.3-2.9), manual III RR = 1.8 (95% CI: 1.4-2.4) and manual IV+V RR = 1.8 (95% CI: 1.3-2.5). Similar relationships were seen in all major geographical regions of Great Britain.
Mortality differences within society are greater than indicated by social class based on occupation alone. Irrespective of social class, men with greater material assets have lower rates of mortality from all causes than men less well endowed, independent of a wide range of lifestyle and biological factors. These findings suggest that mortality differences within our society are closely related to relative wealth.
有人提出，社会群体之间的死亡率差异可能大于基于职业的社会阶层所显示的差异。我们使用住房和汽车拥有情况作为社会阶层内社会经济地位的额外指标，研究了社会阶层与死亡率之间的关系。
对一组代表英国中年男性社会阶层分布的男性进行前瞻性研究。
英格兰、威尔士和苏格兰24个城镇中的每个城镇的一家全科诊所。
在对7735名40 - 59岁男性进行初始筛查五年后，7262名男性（占原始队列的94%）通过填写邮政问卷提供了住房保有情况和汽车拥有情况的信息。
在邮政问卷后平均9.8年（范围8.5 - 11.0年）的随访期间，所有原因、心血管疾病、癌症和其他非心血管疾病导致的死亡。
在随访期间，7262名男性中共有946人因各种原因死亡。所有原因、心血管疾病、癌症和其他非心血管疾病的最低死亡率出现在非体力劳动社会阶层I和II。即使在对广泛的风险因素进行调整后，体力劳动社会阶层III和IV + V的死亡风险仍比社会阶层I + II显著增加40%（相对风险[RR] = 1.4，95%置信区间[CI]：1.2 - 1.7；RR = 1.4，95% CI：1.1 - 1.7）。在所有社会阶层组中，那些同时拥有住房和汽车的人死亡率低于那些两者都没有的人，即使在对广泛的风险因素和就业状况进行调整后也是如此。与同时拥有住房和汽车的社会阶层I + II相比，每个社会群体中所有没有住房和/或汽车的人死亡风险显著增加约两倍。非体力劳动I + II的调整后RR = 2.1（95% CI：1.5 - 2.9），非体力劳动III的RR = 2.0（95% CI：1.3 - 2.9），体力劳动III的RR = 1.8（95% CI：1.4 - 2.4），体力劳动IV + V的RR = 1.8（95% CI：1.3 - 2.5）。在英国所有主要地理区域都观察到了类似的关系。
社会内部的死亡率差异大于仅基于职业的社会阶层所显示的差异。无论社会阶层如何，拥有更多物质资产的男性因所有原因导致的死亡率低于资产较少的男性，这与广泛的生活方式和生物学因素无关。这些发现表明，我们社会中的死亡率差异与相对财富密切相关。
