Socioeconomic differences in dietary patterns among middle-aged men and women

The aim of the study is to (i) identify common dietary patterns, (ii) study socioeconomic differences in these dietary patterns, and (iii) assess whether they contribute to socioeconomic differences in biological risk factors. The data come from the Whitehall II study of London civil servants, who participated in the third phase (1991-1993) and were 39-63-years old (N=8004). Food frequency questionnaire and socioeconomic background information was from a questionnaire, and biological risk factors from a medical screening. Six dietary patterns were identified. In reference to high employment grade men, the odds ratios of low grade men consuming the 'unhealthy' or the 'very unhealthy' diet were 1.26 and 3.34, respectively, while the odds for the 'French' diet was 0.13. Among women the corresponding odds were 2.98, 6.19 and 0.25. Adjusting for spouse's socioeconomic status and to a lesser extent smoking and exercise as well as job control attenuate these grade differences somewhat. Among men and women adjusting for dietary patterns accounted for about 25-50 per cent of grade differences in HDL and serum triglyceride levels.     

女性亚临床期颈动脉粥样硬化与心血管危险因素的关系

目的探讨女性亚临床期颈动脉粥样硬化与心血管危险因素的关系,指导健康体检实践。方法收集女性体检人群835例,均行颈动脉超声检查,以颈动脉中内膜增厚和粥样斑块形成作为亚临床期颈动脉粥样硬化评价指标并分为颈动脉中内膜增厚组、粥样斑块形成组、中内膜增厚或粥样斑块形成组,比较心血管危险因素：年龄、血压、血糖、体重指数、腰围、血总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL—C）和高密度脂蛋白胆固醇（HDL—C）对亚临床期颈动脉粥样硬化的影响。结果心血管危险因素均对亚临床期颈动脉粥样硬化产生影响,且随着危险水平的上升,颈动脉粥样硬化检出率持续上升;随着危险因素聚集个数的增加,颈动脉粥样硬化检出率明显增加。增龄、高血压、血脂异常、超重及糖尿病为亚临床期颈动脉粥样硬化的主要危险因素;Logistic多元回归分析显示：高龄、高血压和高LDL—C、低HDL—C是亚临床期颈动脉粥样硬化的独立影响因素（X2值分别为114．35、16．66、12．23、8．40,P〈0．05）,其中增龄对亚临床期颈动脉粥样硬化影响最强。结论女性亚临床期颈动脉粥样硬化的主要危险因素与导致心血管病的主要危险因素基本一致;亚临床期颈动脉粥样硬化的检测适用于45岁以上体检人群的筛查;亚临床期颈动脉粥样硬化的患病危险为多因素、多层次,早期干预应多方位、多元化。     

Socioeconomic inequalities and disability pension in middle-aged men

BACKGROUND: The issue of inequalities in health has generated much discussion and socioeconomic status is considered an important variable in studies of health. It is frequently used in epidemiological studies, either as a possible risk factor or a confounder and the aim of this study was to analyse the relation between socioeconomic status and risk of disability pension. METHODS: Five complete birth year cohorts of middle-aged male residents in Malmo were invited to a health survey and 5782 with complete data constituted the cohort in this prospective study. Each subject was followed for approximately 11 years and nationwide Swedish data registers were used for surveillance. RESULTS: Among the 715 men (12%), granted disability pension during follow-up, three groups were distinguished. The cumulative incidence of disability pension among blue collar workers was 17% and among lower and higher level white collar workers, 11% and 6% respectively. With simultaneous adjustment for biological risk factors and job conditions, the relative risk for being granted a disability pension (using higher level white collar workers as reference) was 2.5 among blue collar workers and 1.6 among lower level white collar workers. CONCLUSIONS: Socioeconomic status, as defined by occupation, is a risk factor for being granted disability pension even after adjusting for work conditions and other risk factors for disease.     

Socioeconomic differences in the burden of disease in Sweden

OBJECTIVE: We sought to analyse how much of the total burden of disease in Sweden, measured in disability-adjusted life years (DALYs), is a result of inequalities in health between socioeconomic groups. We also sought to determine how this unequal burden is distributed across different disease groups and socioeconomic groups. METHODS: Our analysis used data from the Swedish Burden of Disease Study. We studied all Swedish men and women in three age groups (15-44, 45-64, 65-84) and five major socioeconomic groups. The 18 disease and injury groups that contributed to 65% of the total burden of disease were analysed using attributable fractions and the slope index of inequality and the relative index of inequality. FINDINGS: About 30% of the burden of disease among women and 37% of the burden among men is a differential burden resulting from socioeconomic inequalities in health. A large part of this unequally distributed burden falls on unskilled manual workers. The largest contributors to inequalities in health for women are ischaemic heart disease, depression and neurosis, and stroke. For men, the largest contributors are ischaemic heart disease, alcohol addiction and self-inflicted injuries. CONCLUSION: This is the first study to use socioeconomic differences, measured by socioeconomic position, to assess the burden of disease using DALYs. We found that in Sweden one-third of the burden of the diseases we studied is unequally distributed. Studies of socioeconomic inequalities in the burden of disease that take both mortality and morbidity into account can help policy-makers understand the magnitude of inequalities in health for different disease groups.     

Gender differences in the association between morbidity and mortality among middle-aged men and women

Objectives. We examined gender differences in mortality, morbidity, and the association between the 2.Methods. We used health data from 2 studies of middle-aged men and women: the British Whitehall II cohort of employees from 20 civil service departments in London and the 1989 French GAZEL (this acronym refers to the French gas and electric companies) of employees of France''s national gas and electricity company. Participants were aged 35 to 55 years when assessed for morbidity and followed up for mortality over 17 years.Results. Male mortality was higher than female mortality in Whitehall II (hazard ratio [HR] = 1.56; 95% confidence interval [CI] = 1.28, 1.91) and the GAZEL cohort (HR = 1.99; CI = 1.66, 2.40). Female excess morbidity was observed for some measures in the Whitehall II data and for 1 measure in the GAZEL data. Only self-reported sickness absence in the Whitehall II data was more strongly associated with mortality among men (P = .01).Conclusions. Mortality was lower among women than among men, but morbidity was not consistently higher. The lack of gender differences in the association between morbidity and mortality suggests that this is not a likely explanation for the gender paradox, which refers to higher morbidity but lower mortality among women than among men.In most regions of the world, life expectancy among women is higher than among men.^1,2 Men are said to be “more vulnerable from the beginning of life,”³ with mortality rates among men being higher than those among women throughout the lifespan.^4,5 Research in the 1970s and 1980s routinely showed higher morbidity among women; this discrepancy between morbidity and mortality rates is referred to as the “gender paradox.”^5–10 However, uniformity in the pattern of gender differences for all measures of morbidity has been questioned.¹¹ At older ages, there is some evidence to suggest that there are minimal gender differences in self-assessed health,¹² as well as substantially higher levels of disability among women.^13,14 The notion of ubiquitous male vulnerability also is challenged by research showing higher mortality among women after cardiac surgery.^15–21It remains unclear whether the gender paradox discrepancy is based on inferences from ecological correlations between morbidity and mortality or whether the discrepancies hold true at the individual level. Furthermore, multiple measures of morbidity, both subjective and objective measures, have rarely been examined in the same study. We tested the hypothesis of greater morbidity among women by examining a range of objective and subjective measures of health among middle-aged men and women. For 3 of the measures included, we compared self-report with an objective measure of morbidity.One explanation for the gender paradox links it to greater stoicism among men and a greater willingness among women to use health services, report health problems,^5,22,23 and factor in less-serious ailments when assessing their own health.²⁴ Although these explanations implicate slightly different mechanisms, they all assume that a woman''s illness is less likely to kill her. More specifically, if women overreport minor health problems or report health problems at an earlier, more benign stage, then the association between morbidity and mortality ought to be smaller among women compared with men. Thus, we examined the evidence for this discrepancy in the association between morbidity and mortality by examining a range of objective and subjective measures of morbidity. We used data on employed men and women aged 30 to 55 years at baseline from 2 cohorts: the Whitehall II study and the GAZEL (this acronym refers to the French gas and electric companies) Study.     

Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden

BACKGROUND: Socioeconomic conditions and lifestyle factors have been found to be related to self-rated health, which is an established predictor of morbidity and mortality. Few studies, however, have investigated the independent effect of material and psychosocial conditions as well as lifestyle factors on self-rated health. METHODS: The association between socioeconomic conditions, lifestyle factors, and self-rated health was investigated using a postal survey questionnaire sent to a random population sample of men and women aged 18-79 years during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities in the central part of Sweden. Multivariate odds ratios for poor self-rated health were calculated for a range of variables. A total of 36 048 subjects with full data were included in the analysis. Similar analyses of the influence of working conditions were conducted among those employed aged 18-64 years (17 820 subjects). RESULTS: The overall prevalence of poor self-rated health was 7% among men and 9% among women. Poor self-rated health was most common among persons who had been belittled, who had experienced economic hardship, who lacked social support, or who had retired early. A low educational level was independently associated with poor self-rated health among men, but not among women. Physically inactive as well as underweight and obese subjects were more likely to have poor self-rated health than other subjects. Working conditions associated with poor self-rated health were dissatisfaction with work, low job control and worry about losing one's job. CONCLUSION: While a cross-sectional study does not allow definite conclusions as to which factors are determinants and which are consequences of poor self-rated, the present findings support the notion that both psychosocial and material conditions as well as lifestyle factors are independently related with poor self-rated health.     

Race-gender differences in the association of trait anger with subclinical carotid artery atherosclerosis: the Atherosclerosis Risk in Communities Study

This paper examines the association between trait anger and subclinical carotid artery atherosclerosis among 14,098 Black or White men and women, aged 48-67 years, in the Atherosclerosis Risk in Communities Study cohort, 1990-1992. Trait anger was assessed using the 10-item Spielberger Trait Anger Scale. Carotid atherosclerosis was determined by an averaged measure of the wall intimal-medial thickness (IMT) of the carotid bifurcation and of the internal and common carotids, measured by high-resolution B-mode ultrasound. In the full study cohort, trait anger and carotid IMT were significantly and positively associated (p = 0.04). In race-gender stratified analysis, the association was strongest and independent only in Black men, among whom a significant trait anger-carotid IMT relation was observed for both the overall trait anger measure (p = 0.004) and the anger reaction dimension (p = 0.001). In Black men, carotid IMT levels increased across categories of overall trait anger and anger reaction, resulting in clinically significant differences (67 microm (95% confidence interval: 23, 110) and 82 microm (95% confidence interval: 40, 125), respectively) from low to high anger. Sociodemographic, lifestyle, anthropometric, and biologic cardiovascular disease risk factors appear to mediate the relation in Black women, White men, and White women. In conclusion, these findings document disparate race-gender patterns in the association of trait anger with subclinical carotid artery atherosclerosis.     

Visceral adiposity and subclinical atherosclerosis in healthy young men

Abstract

Background: Atherosclerosis begins in childhood and develops silently for decades before clinical events such as myocardial infarction or stroke occur. Only few studies have evaluated the relationship between CVD risk factors and carotid artery Intimal Media Thickness (IMT) in young asymptomatic people. Aim: The aim of this study is to investigate risk factors for cardiovascular disease associated with higher Carotid Intimal Media Thickness (IMT) in healthy young subjects. Methods: A cohort of 106 healthy young men, mean age 21?±?2 years (mean?±?SD), BMI 24.4?±?2.8 (kg/m²), on military duty, participated in this cross-sectional study. Waist circumference, carotid intima–media thickness (IMT), blood pressure, and plasma concentrations of relevant metabolic parameters were measured at fasting. Smoking and habitual dietary patterns were evaluated by a semiquantitative questionnaire. Results: The population was divided into two groups on the basis of IMT values: the lowest three quartiles versus the highest quartile (cut-off value?=?0.7?mm). BMI, waist circumference, systolic (SBP), and diastolic (DBP) blood pressure were significantly higher in the group with higher IMT (p?=?0.02). All other variables, including dietary parameters and smoking, were similar in the two groups. Data analysis showed that IMT values correlated positively with SBP (r?=?0.22; p?=?0.025), DBP (r?=?0.27; p?=?0.005), waist circumference (r?=?0.29; p?=?0.002), and fat mass (r?=?0.24; p?=?0.01), and negatively with kcal/kg of body weight (r?=??0.220.22; p?=?0.022) – an indirect marker of physical activity. Based on multiple regression analysis, waist circumference and DBP were the only variables independently associated with IMT (p?=?0.029). Conclusions: In a non-selected sample of healthy young adult males, a larger waist circumference and a higher diastolic blood pressure – albeit within normal values – are the only parameters independently associated with higher IMT.     

代谢综合征不同组分对女性亚临床期颈动脉粥样硬化的影响

目的探讨代谢综合征（MS）不同组分、聚集数目及聚集方式与女性亚临床期颈动脉粥样硬化的关系,为心脑血管疾病防治提供更多信息。方法整群抽取3个事业单位女性体检人群835例,按照ATPⅢ标准定义MS。按年龄分组为25岁～、45岁～、65岁～;根据MS五个组分的聚集数目分为0、1、2、3、4、5组;再按照MS组分不同聚集方式分为16组;对上述各组人群行颈动脉超声检查,以颈动脉中内膜增厚和粥样斑块形成作为亚临床期颈动脉粥样硬化评价指标,比较MS各组分,各组分不同的聚集数目及不同的聚集方式对业临床期颈动脉粥样硬化的影响。结果MS总患病率27．8％,五个组分异常率分别为中心性肥胖69．3％,高血压31．0％,高密度脂蛋白胆圊醇减低31．0％,高三酰甘油血症21．4％,高血糖18．1％。结果显示,中心性肥胖、高血压、低高密度脂蛋白胆同醇致颈动脉粥样硬化风险最强。随着组分聚集数目增加,颈动脉粥样硬化检出率不同程度增加,与0个组分相比,分别具有1、2、3、4、5个组分者患动脉粥样硬化的风险分别是0个组分的1．4倍、2．0倍、3．4倍、5．7倍及7．1倍;MS各组分不同的聚集方式对颈动脉粥样硬化产生不同的影响,常见的聚集方式为含有中心性肥胖组分与其他各组分的聚集。结论MS每一组分均是亚临床期颈动脉粥样硬化的独立危险因素;随着组分聚集数目增加颈动脉粥样硬化患病风险成算术级别增加;M5各组分不同的聚集方式对颈动脉粥样硬化产生显著影响。     

Socioeconomic position and risk of short-term weight gain: Prospective study of 14,619 middle-aged men and women

Background  

The association between socioeconomic position in middle age and risk of subsequent, short-term weight gain is unknown. We therefore assessed this association in a prospective population based cohort study in Norfolk, UK.     

Endogenous hormones and carotid atherosclerosis in elderly men

The aging process is characterized by a number of gradual changes in circulating hormone concentrations as well as a gradual increase in the degree of atherosclerosis. The authors studied whether serum hormone levels are related to atherosclerosis of the carotid artery in independently living, elderly men. In 1996, 403 men (aged 73-94 years) were randomly selected from the general population of Zoetermeer, the Netherlands. Carotid artery intima-media thickness was determined. Serum concentrations of testosterone; estrone; estradiol; dehydroepiandrosterone and dehydroepiandrosterone sulfate; insulin-like growth factor I (IGF-I) (total and free) and its binding proteins IGFBP-1, IGFBP-2, and IGFBP-3; and leptin were measured. After the authors adjusted for age, serum testosterone, estrone, and free IGF-I were inversely related to intima-media thickness. The strength of these relations was as powerful in subjects with as in those without prevalent cardiovascular disease. Serum estradiol; dehydroepiandrosterone sulfate; total IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3; and leptin showed no association. These findings suggest that endogenous testosterone, estrone, and free IGF-I levels may play a protective role in the development of atherosclerosis in aging men.     

Standing at work and progression of carotid atherosclerosis

OBJECTIVES: The association between the amount of standing at work and the progression of carotid intima media thickness (IMT) was studied among 584 active working men participating in the Kuopio Ischemic Heart Disease Risk Factor Study. METHODS: Ultrasound measurements of atherosclerotic changes in the carotid arteries were performed at the beginning of the study and after 4 years. Analyses of changes in IMT included adjustments for risk factors and stratification by base-line levels of atherosclerosis and prevalent ischemic heart disease (IHD). RESULTS: Significant relationships were found between the amount of standing at work and atherosclerotic progression. After adjustment for the heaviness of the work, psychosocial job factors, income, and biological and behavioral risk factors, the mean change in maximum IMT for those standing not at all, a little, a lot, and very much was 0.24, 0.25, 0.28, and 0.33 mm, respectively. For men with IHD the respective changes were 0.08, 0.15, 0.37, and 0.75 mm -- a 9-fold difference between the no-exposure and high-exposure group. For the men with carotid stenosis, the respective difference was 3-fold. CONCLUSIONS: These findings provide the first empirical support in a population study for the role of hemodynamic factors in the progression of atherosclerosis induced by long-term standing. Men with carotid stenosis or IHD appear especially vulnerable to the adverse effects associated with standing at work. Reducing the duration of standing at work should be considered both in the occupational rehabilitation of such patients and in the primary prevention of atherosclerosis.     

Sex differences in subclinical atherosclerosis by race/ethnicity in the multi-ethnic study of atherosclerosis

Sex differences in cardiovascular disease mortality are more pronounced among non-Hispanic whites than other racial/ethnic groups, but it is unknown whether this variation is present in the earlier subclinical stages of disease. The authors examined racial/ethnic variation in sex differences in coronary artery calcification (CAC) and carotid intimal media thickness at baseline in 2000-2002 among participants (n = 6,726) in the Multi-Ethnic Study of Atherosclerosis using binomial and linear regression. Models adjusted for risk factors in several stages: age, traditional cardiovascular disease risk factors, behavioral risk factors, psychosocial factors, and adult socioeconomic position. Women had a lower prevalence of any CAC and smaller amounts of CAC when present than men in all racial/ethnic groups. Sex differences in the prevalence of CAC were more pronounced in non-Hispanic whites than in African Americans and Chinese Americans after adjustment for traditional cardiovascular disease risk factors, and further adjustment for behavioral factors, psychosocial factors, and socioeconomic position did not modify these results (for race/sex, P(interaction) = 0.047). Similar patterns were observed for amount of CAC among adults with CAC. Racial/ethnic variation in sex differences for carotid intimal media thickness was less pronounced. In conclusion, coronary artery calcification is differentially patterned by sex across racial/ethnic groups.     

Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden

BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.     

2型糖尿病患者颈动脉硬化与亚临床甲状腺功能减退症关系的研究

目的 研究2型糖尿病(T2DM)患者颈动脉硬化与亚临床甲状腺功能减退症(甲减)的关系.方法 选择2010年1-12月住院T2DM患者408例,根据甲状腺功能分为甲状腺功能正常(甲功正常)组(376例)和亚临床甲减组(32例),对两组颈动脉硬化的发病率进行分析,并使用Logistic回归分析颈动脉硬化的危险因素.结果 亚临床甲减组患者与甲功正常组患者年龄、病程、体质指数、空腹血糖、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇、三酰甘油、糖化血红蛋白比较差异无统计学意义(P＞0.05).但亚临床甲减组的颈动脉硬化发病率[81.2％(26/32)]明显高于甲功正常组[61.4％(231/376)],两组比较差异有统计学意义(P=0.026).Logistic回归分析提示年龄和促甲状腺激素(TSH)是颈动脉硬化的危险因素(OR值分别为1.178和1.227,P值分别为0.000和0.019),HDL-C是颈动脉硬化的保护因素(OR=0.284,P=0.003).结论 T2DM伴随亚临床甲减患者存在更高的颈动脉硬化发病率,并且TSH升高是颈动脉硬化的独立危险因素.     

Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis

The authors studied associations between ankle-brachial index (ABI) and subclinical atherosclerosis in the Multi-Ethnic Study of Atherosclerosis. Participants included 3,458 women (average age = 62.6 years) and 3,112 men (average age = 62.8 years) who were free of clinically evident cardiovascular disease. Measurements included ABI, carotid artery intima-media thickness, and coronary artery calcium assessed with computed tomography. Five ABI categories were defined: <0.90 (definite peripheral arterial disease (PAD)), 0.90-0.99 (borderline ABI), 1.00-1.09 (low-normal ABI), 1.10-1.29 (normal ABI), and > or =1.30 (high ABI). Compared with that in men with normal ABI, significantly higher internal carotid artery intima-media thickness was observed in men with definite PAD (1.58 vs. 1.09; p < 0.001), borderline ABI (1.33 vs. 1.09; p < 0.001), and low-normal ABI (1.18 vs. 1.09; p < 0.001) after adjustment for confounders. Fully adjusted odds ratios for a coronary artery calcium score greater than 20 decreased across progressively higher ABI categories in both women (2.85 (definite PAD), 1.27 (borderline ABI), 1.11 (low-normal ABI), 1.00 (normal ABI; referent), and 0.78 (high ABI); p for trend = 0.0002) and men (3.26 (definite PAD), 1.72 (borderline ABI), 1.14 (low-normal ABI), 1.00 (normal ABI; referent), and 1.43 (high ABI); p for trend = 0.0002). These findings indicate excess coronary and carotid atherosclerosis at ABI values below 1.10 (men) and 1.00 (women) and may imply increased risk of cardiovascular events in persons with borderline and low-normal ABI.