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健康生活方式和社会经济状况与死亡率和心血管疾病发病率的关系
作者:小柯机器人 发布时间:2021/4/18 12:49:38

华中科技大学同济医学院潘安课题组研究了健康生活方式和社会经济状况与死亡率和心血管疾病发病率的关系。2021年4月14日,该研究发表在《英国医学杂志》上。

为了研究总体生活方式是否介导社会经济状况(SES)与死亡率和心血管疾病(CVD)的关联,以及生活方式和SES与健康结局的相互作用或联合关系的程度,研究组使用美国国家健康和营养检查调查(NHANES)和英国生物银行进行了一项基于人群的队列研究。

研究组共招募了44462名20岁及以上的美国成年人和399537名37-73岁的英国成年人。通过潜在类别分析,利用家庭收入、职业或就业状况、教育水平和健康保险获得暴露SES,并将其定义为三个水平(低、中、高)。健康生活方式评分利用从不吸烟、不大量饮酒、体育运动的前三分之一和更高的饮食质量等信息来构建。主要结局为全因死亡率,英国生物库还分析了心血管疾病死亡率和发病率。

美国NHANES在平均11.2年的随访中记录了8906例死亡,英国生物银行在平均8.8-11.0年的随访中记录了229例死亡和6903例CVD事件。在低SES成人中,美国NHANES和英国生物银行的年龄调整死亡风险分别为22.5例和7.4例/1000人-年,英国生物银行的年龄调整CVD风险为2.5例/1000人-年。在高SES成人中,相应风险分别为11.4例、3.3例和1.4例/1000人-年。

与高SES成人相比,低SES成人的全因死亡率(美国NHANES的风险比为2.13,英国生物银行的风险比为1.96)、CVD死亡率和偶发CVD率较高,生活方式介导的比例分别为12.3%、4.0%、3.0%和3.7%。在美国NHANES中没有观察到生活方式和SES之间的显著交互作用,而在英国生物银行中,生活方式和健康结局之间的相关性在低SES人群中更强。

与高SES和三个或四个健康生活方式因素的成人相比,低SES和没有或只有一个健康生活方式因素的成人在全因死亡率(美国NHANES为3.53,英国生物银行为2.65)、CVD死亡率(2.65)和CVD事件(2.09)方面的风险更高。

总之,不健康的生活方式在美国和英国成年人健康方面的社会经济不平等中占一小部分;因此,仅提倡健康的生活方式可能无法大幅减少健康方面的社会经济不平等,有必要采取其他措施解决健康的社会决定因素。然而,在不同的SES亚组中,健康的生活方式与较低的死亡率和心血管疾病风险相关,健康生活方式在减轻疾病负担方面仍有重要作用。

附:英文原文

Title: Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies

Author: Yan-Bo Zhang, Chen Chen, Xiong-Fei Pan, Jingyu Guo, Yanping Li, Oscar H Franco, Gang Liu, An Pan

Issue&Volume: 2021/04/14

Abstract:

Objective To examine whether overall lifestyles mediate associations of socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) and the extent of interaction or joint relations of lifestyles and SES with health outcomes.

Design Population based cohort study.

Setting US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank.

Participants 44462 US adults aged 20 years or older and 399537 UK adults aged 37-73 years.

Exposures SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality.

Main outcome measures All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries.

Results US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank.

Conclusions Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.

DOI: 10.1136/bmj.n604

Source: https://www.bmj.com/content/373/bmj.n604

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj