社会经济地位与全因死亡风险队列研究

A cohort study on socioeconomic status and the risk of all-cause mortality

目的探讨社会经济地位(socioeconomic status,SES)对全死因的影响。方法采用分层整群随机抽样方法,于2010年对抽取的贵州省12个县(市、区)≥18岁常住居民进行基线调查,于2016—2020年对该队列所有人群进行随访;SES由家庭人均年收入、个人文化程度和职业构成,分别按照等级次序由低到高进行赋分(1~4分),计算参与者SES综合得分,并按四分位数将SES分为4个等级。运用Cox比例风险回归模型来分析SES对全死因的影响。结果共调查9280人,删除失访及SES信息缺失者,最终共纳入分析5206人。中位随访6.45年,在随访期间内共死亡98例。多因素Cox回归结果显示,家庭人均年收入在5121~<10000、≥10000元的人群死亡风险分别为家庭人均年收入<2700元人群的0.49倍(HR=0.49,95%CI:0.26~0.92)、0.40倍(HR=0.40,95%CI:0.19~0.82),随着收入增加,死亡风险呈逐渐降低趋势(P_(趋势)=0.004);文化程度为小学毕业、初中毕业、高中及以上人群死亡风险分别为文盲、半文盲人群的0.74倍(HR=0.74,95%CI:0.44~1.25)、0.30倍(HR=0.30,95%CI:0.14~0.65)、0.49倍(HR=0.49,95%CI:0.18~1.32),随着文化程度提升,死亡风险呈逐渐降低趋势(P_(趋势)=0.005);职业方面,与无业人群相比,其他职业类别人群死亡风险的差异无统计学意义(P>0.05)。SES综合得分在7~8、≥9分人群死亡风险分别为SES综合得分<6分人群的0.50倍(HR=0.50,95%CI:0.27~0.90)、0.27倍(HR=0.27,95%CI:0.11~0.63),随着SES提高,死亡风险呈逐渐降低趋势(P_(趋势)<0.01)。亚组分析结果显示,SES对人群全死因的影响存在明显性别、地区差异。随着男性SES的提高,死亡风险呈逐渐降低趋势(P_(趋势)<0.01),而女性SES与全因死亡风险无关;在农村人口中,随着SES提高,死亡风险呈逐渐降低趋势(P_(趋势)<0.01),而在城市人口中未发现SES与成人死亡风险存在关联。结论SES与全因死亡风险成负相关,对农村、男性人群影响更为显著。

Objective To explore the impact of socioeconomic status(SES)on all-cause mortality.Methods A stratified cluster random sampling method was used to select 9280 permanent residents aged 18 and above in12 counties(cities and districts)of Guizhou province in 2010 for a baseline survey,and the whole cohort was followed up from 2016 to 2020.SES was ranked based on annual household income per capita,personal education level and occupation,each of which was graded from low to high(1-4 points),summed up to a comprehensive SES score for each participant.SES was divided into four grades according to the quartiles of the calculated SES scores.Proportional hazard Cox regression model was used to analyze the effect of SES on all-cause mortality.Results The participants who were lost to follow-up or with missing SES information were excluded,resulting in a total of 5206 people included in the analysis.The median follow-up period was 6.45 years,and 98 participants died during the follow-up period.The results of multivariate Cox proportional hazard regression analysis showed that the mortality risk of people with annual household income per capita of 5121-10000 CNY and≥10000 CNY was 0.49 times(HR=0.49,95%CI:0.26-0.92)and 0.40 times(HR=0.40,95%CI:0.19-0.82)of those with annual household income per capita of 2700 CNY,respectively,with the increasing of income,the mortality risk gradually decreased(P_(trend)=0.004);the mortality risk decreased among the participants with illiterates or semiliterates in comparison to those with informal education(primary school graduation:HR=0.74,95%CI:0.44-1.25);middle school graduation:HR=0.30,95%CI:0.14-0.65;high school and above:(HR=0.49,95%CI:0.18-1.32),with the improvement of education,the risk of mortality gradually decreased(P_(trend)=0.005).In terms of occupation,compared with the unemployed,there was no significant difference in mortality risk between other occupational groups(P<0.05).And with higher SES scores compared to those with the SES scores of less than 6(SES score of 7-8:HR=0.50,95%CI:0.27-0.90,≥9:HR=0.27,95%CI:0.11-0.63),with the improvement of SES,the mortality risk gradually decreased(P_(trend)0.01).Subgroup analysis showed significant gender and regional disparities in the effects of SES on all-cause mortality.In specific,the risk of death gradually decreased with the improvement of SES in men(P_(trend)0.01),while SES was not associated with the risk of all-cause mortality in women.In rural population,the all-cause mortality risk gradually decreased with the increase of SES(P_(trend)0.01),but this negative association was not observed in urban population.Conclusions SES may be negatively correlated with the risk of all-cause mortality,especially in rural areas and in male population.