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标题：Family Socioeconomic Position at Birth and Future Cardiovascular Disease Risk: Findings From the Aberdeen Children of the 1950s Cohort Study
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作者：Debbie A. Lawlor ; Georgina Ronalds ; Sally Macintyre 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：7
页码：1271-1277
DOI：10.2105/AJPH.2005.066290
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed the association of father’s social class, recorded at the time of birth, with coronary heart disease and stroke in a British cohort of 11106 individuals born in the 1950s. Methods. Survival analysis was used to relate social class at birth to the occurrence of either fatal or nonfatal coronary heart disease or stroke. Results. Rates of coronary heart disease and stroke increased across the social class distribution from highest to lowest, and patterns of association were similar for the 2 outcomes. The gender-adjusted hazard ratio of experiencing either coronary heart disease or stroke comparing the manual and nonmanual social class categories was 1.52 (95% confidence interval [CI]=1.14, 2.02). This ratio fell to 1.41 (95% CI = 1.05, 1.88) after adjustment for indicators of intrauterine and childhood growth. Further adjustment for educational attainment reduced the ratio to 1.28 (95% CI=0.94, 1.75). Conclusions. We found that social class at birth was associated with risk of fatal and nonfatal cardiovascular disease among individuals born in the 1950s, a period of relative prosperity and after the introduction of the welfare state in Britain. This relation appeared to be mediated in part through educational attainment. Several studies conducted in different populations have shown associations between adverse childhood socioeconomic position (SEP) and coronary heart disease (CHD) and stroke that are independent of adult SEP. 1 ^– 14 However, in many of these studies, childhood SEP has been retrospectively reported in adulthood, 3 ^– 6 ^, 8 ^, 11 and most of the studies have included participants born in the 1930s or earlier. 2 ^, 4 ^– 7 ^, 11 Accuracy of adult recall of childhood SEP is unlikely to be affected by CHD or stroke status; thus, any misclassification would be nondifferential and might actually lead to results underestimating the true association. 15 It is important to study individuals born in recent decades because the effects of childhood SEP on health outcomes vary over time. 16 Children born in recent decades into families of low socioeconomic status, particularly those born after World War II in nations with publicly funded health and welfare systems (e.g., Britain), are likely to have experienced better standards of living than those born in earlier years. Evidence of this trend is provided by infant mortality rates, which are sensitive to socioeconomic circumstances. For example, between 1901 and 1905 infant mortality was 150 per 1000 live births in England and Wales and 130 in Scotland; by the period 1941 through 1945, these rates had decreased to 60 and 80 per 1000, respectively, and a marked decline over the subsequent decade resulted in rates of 30 and 37 per 1000 in the early to mid-1950s. 17 Because of the introduction of welfare reforms throughout Britain in the late 1940s, together with improvements in the British and world economies beginning in the mid-1950s, those born in the most deprived groups in the 1950s are likely to have experienced better conditions than those born in the most deprived groups in the 1930s and earlier. 18 ^– 20 If the associations found in previous studies largely represent the effects of extremely adverse socioeconomic circumstances such as those that gave rise to the high levels of infant mortality observed in the early 1900s, then, given that these conditions (and the associated infant mortality) have improved over time, one might expect only weak or no associations between childhood SEP and cardiovascular disease risk in studies of populations born in the 1950s or later. If this were the case, it would suggest that the varying socioeconomic conditions experienced by contemporary children might not have important effects on their future cardiovascular disease risks. Only 4 studies have examined the association of childhood SEP with adult cardiovascular disease outcomes among individuals born in the latter half of the 20th century, and all of these investigations have revealed inverse associations. 9 ^, 10 ^, 13 ^, 21 These studies have predominantly involved only men, and all have assessed cardiovascular disease mortality. Determining whether childhood SEP affects nonfatal CHD and stroke events is also important because it would suggest an effect on the atherosclerotic process and not simply the acute event, as well as the existence of socioeconomic inequalities in cardiovascular disease morbidity rather than simply premature mortality. We assessed the association of childhood SEP, recorded at the time of birth, with fatal and nonfatal CHD and stroke in a large cohort of women and men born in Scotland in the 1950s.