工作中缺乏体力活动(静坐工作)与心血管疾病的职业流行病学

西方许多大型心血管病流行病学研究资料表明，缺乏体力活动与冠心病之间有病因联系，并承认体力活动是心血管疾病的一个保护因素。经济技术的飞速发展，静坐式工作普遍增多。静坐式工作或工作中缺乏体力活动与心血管病的关系受到重视。影响职业人群心血管病的危险因素众多，如何控制多种混杂因素、分离出体力活动的独立作用较难，而且心血管病危险因素：血压、血脂、心率等都可能受到体力活动的影响而改变，静坐工作可否能成为职业人群心血管病的一个独立危险因素等问题尚需进一步精深的流行病学研究来解决。     

女性体力活动、膳食因素与心血管疾病危险因素

目的 探讨健康成年女性人群体力活动和膳食与心血管疾病危险因素之间多因素综合相关关系。方法 通过标准化的体力活动问卷（MOSPA）和膳食调查方法评价女性日常体力活动和膳食营养素摄入状况，并测量其心血管疾病危险因素水平（包括体质指数、血压、机体氧化应激水平、胰岛素敏感性和血脂水平），采用典型相关分析的统计方法探讨女性体力活动和膳食与心血管疾病危险因素之间的关系。结果 体力活动、膳食与心血管疾病危险因素之间的相关关系主要表现为：膳食总能量和抗氧化物的摄入与机体抗氧化状态之间，以及体力活动能耗与血脂之间的关系。结论 体力活动、膳食与心血管疾病危险因素之间有较密切的相关关系。     

体力活动与心血管病危险因素

为探索不同体力活动强度人群的心血管病主要危险因素水平的差异，采用分层随机抽样方法，对上海农村心血管病监测区３５～６４岁的男女共１１９７人进行心血管病危险因素和体力活动强度的调查。结果显示，体力活动能明显降低收缩压、舒张压、高血压患病率和体重指数，并可能有降低血清总胆固醇和升高高密度脂蛋白胆固醇的作用。提示通过体力活动能降低心血管病危险因素的水平，从而有利于心血管病的防治。     

职业性、休闲性体力活动与其他心脑血管病危险因素关系

目的 探讨职业性、休闲性体力活动与其他心脑血管病危险因素的关系。方法 利用1997年及1998年广东省糖尿病流行病学调查资料分析不同强度等级职业性、休闲性体力活动与其他心脑血管病危险因素的关系。结果职业性、休闲性体力活动的城乡、性别分布不同；男性较女性暴露于心脑血管病的危险因素的机会更大；调整年龄、性别、城乡、受教育程度、家庭总收入和职业性体力活动(或休闲体力活动)后，随着职业性体力活动强度的增加，心脑血管病危险因素(吸烟外)的危险性随之降低；休闲性体力活动强度与心脑血管病危险因素则没有明显联系。结论 缺乏职业性体力活动可使心脑血管病危险因素增加。     

江苏农村发达地区心血管病危险因素流行特征分析

目的：了解农村发达地区心血管病危险因素流行特征。方法：采用分层整群抽样的方法，随机抽取常熟市5个镇所有35岁以上常住居民，测量身高、体重、腰围、臀围、血压和收集其他相关资料，并对其中5个村居民进行血脂检测。结果：心血管病危险因素中，吸烟、饮酒、超重、腰臀比过大、心血管病家族史和体力活动过轻的百分率分别为25．50％、20．20％、22．25％、37．55％、21．95％和31．36％；心血管病危险因素的分布存在性别、年龄和职业差异；多因素Logistic回归分析结果发现，年龄、性别、饮酒、超重、腰臀比过大、心血管病家族史、体力活动过轻是心血管病的危险因素。结论：应大力开展健康教育，加强危险因素的监测和干预，以降低居民心血管病的发病率和死亡率。     

绝经后女性体力活动水平对心血管健康影响的研究进展

绝经后女性由于年龄增长,雌激素缺乏,导致体质量增加、腹部脂肪堆积、血脂异常等危险因素增多。因此,及早关注并重视绝经后女性的健康状况及体力活动状况,对于提高绝经后女性的生活质量和生命质量有重要意义。本研究从体力活动对绝经后女性心血管疾病发病风险的影响和体力活动对绝经后女性心血管健康相关的人体学指标的影响来分析及总结绝经后女性体力活动水平对心血管健康的影响,揭示体力活动对降低绝经后女性心血管疾病风险的重要作用。     

广西宾阳县监测人群慢性病相关危险因素现状分析

[目的]了解慢性病及其危险因素在我县不同地区、不同人群中的流行状况,为制定适合本地区的干预措施提供基础数据.[方法]采用多阶段分层随机整群抽样的方法抽取480个调查户,从480个调查户中抽取480名15～69岁常住居民作为调查对象,采取集中调查和入户调查相结合的方式进行调查表调查、人体测量和收集社会经济、文化、卫生等资料.[结果]48.13%的监测人群有一种或一种以上的危险因素;监测人群的吸烟率、饮酒率、不合理膳食、超重率、肥胖率、体力活动不足、精神因素、伤害等危险因素分别为26.5%、48.2%、32.6%、12.9%、11.9%、18.7%、15.6%、8.9%;高血压患病率为24.2%;男性接触吸烟、饮酒两项危险因素高子女性,缺乏体力活动及精神因素为女性高于男性;危险因素随着年龄增加呈升高趋势;吸烟行为、肥胖、体力活动不足是高血压的危险因素.[结论]慢性病危险因素处于高水平状态,慢性病的发生与不良行为和社会生活方式密切相关,包括吸烟、酗酒、不合理膳食、缺乏体力活动、精神因素等.     

天津市居民社会经济地位对健康相关行为的影响

目的了解天津市居民的社会经济地位与健康相关行为的关系,为制定针对不同人群的公共卫生干预政策提供科学依据。方法采用2010年天津市慢性病危险因素调查问卷和方法,问卷主要内容包括一般信息(年龄、性别、职业、受教育水平等)和吸烟、饮酒、饮食、睡眠、身体活动状况,选取受教育水平和职业构建社会经济地位(SES)复合指数。采用SPSS 19.0进行数据的统计分析,率的比较用χ~2检验,采用logistic回归分析其与吸烟、饮酒、睡眠、锻炼情况及减盐行动等的关系。结果最终3 953例样本纳入分析,受教育水平以初中学历最多(35.59%)。职业分布中以无业者和工人占比最多,分别为20.77%和20.72%。天津市居民吸烟率为27.37%,饮酒率为25.47%,睡眠充足率为95.09%,锻炼率为9.87%,减盐行动率为61.61%。调整年龄因素后,随着SES复合指数得分的增加,全人群饮酒情况、睡眠情况和减盐行动均增加;男性减盐行动增加;女性吸烟行为降低,而饮酒行为和减盐行动升高,均有统计学意义(P0.05)。结论不同社会经济地位对人群健康相关行为有影响并呈现差异,对女性的影响尤为明显,应对社会经济地位较低的人群开展有针对性的干预。     

广州市中年人群体力活动与其他心血管病危险因素关系的研究

目的 了解广州市城乡中年人群的体力活动状况及其与心血管病主要危险因素的关系。方法 采用整群随机抽样方法调查广州市35－59岁城市居民1124人及农村居民1029人，按照国家“九五”攻关课题（编号96－906－02－01）统一方案、采用标准化方法进行。结果 农村人群中等强度及以上的体力活动时间平均占全天的20．7％，明显高于城市人群（7．2％）；农村人民不活动或少活动的时间占全天的60．5％，较城市人群（73．7％）少。农村人群高胆固醇现患率、高密度脂蛋白胆固醇降低率、高血糖现患率和超重率均低于城市人群，但吸烟率和饮酒率明显高于城市人群。多元线性回归分析显示，不活动和少活动时间对血压升高、血中胆固醇升高、高密度脂蛋白胆固醇降低及体重增加的影响均有非常显性意义。结论 缺乏体力活动会使心血管病危险因素有增加的趋势。     

肥胖与女性2型糖尿病发病关系又添新证据

美国匹兹堡大学医学中心Rana等报告，肥胖和体力活动少均增加女性罹患2型糖尿病的危险，且肥胖的影响更大。研究人员对68907名基线时无糖尿病、心血管病及肿瘤的女护士进行了16年随访，以体重指数（BMI）和腰围作为肥胖的衡量指标，以每周中等以上强度运动的平均时间计算出MET评分，作为计量体力活动的指标。     

The Association Between Socioeconomic Status and Cardiovascular Risk Factors Among Middle-Aged and Older Men and Women

Studies of gender differences in the association between socioeconomic status (SES) and cardiovascular risk factors have produced mixed findings. The purpose of this research was to examine whether the association between SES and cardiovascular risk factors differed between older men and women. Using data on physical measures and biomarkers from the 2006 Health and Retirement Study (N = 2,502 men; N = 3,474 women), linear regression models were used to estimate the association between SES and seven cardiovascular risk factors. Interactions between gender and SES were tested. For all seven risks assessed, we observed significant associations of selected SES factors to cardiovascular risk for men and/or women. In all of these cases, lower SES was associated with higher cardiovascular risk. However, for six of the factors, we also observed gender differences in the association between SES and cardiovascular risk, such that lower SES was associated with higher cardiovascular risk for women but not for men. These findings suggest that the association between SES and cardiovascular risk is more pronounced for women than for men. Implementing interventions to reduce cardiovascular risk factors, particularly among older women with lower SES, might, over time, reduce cardiovascular disease in women and improve quality of life.     

Impact of socioeconomic status on longitudinal accumulation of cardiovascular risk in young adults: the CARDIA Study (USA)

Our objectives were to describe the trajectories of biological risk factors of cardiovascular disease in young adults, and to study the association of socioeconomic status (SES) with aggregate risk scores that summarize longitudinal risk accumulation from multiple risk factors. We used data from a prospective, bi-racial, cohort study of 18-30-year-old adults in the USA, initiated in 1985, with 10-year follow-up. SES was measured by parental education level, financial hardship during the study, and the participant's education level by the end of the study. We studied growth patterns of seven biological risk factors for cardiovascular disease using a semi-parametric, class-mixture model to identify clusters of individuals with distinct growth trajectories. Risk scores that summarize risk from all seven risk factors were created to reflect risk at baseline, longitudinal risk change over 10 years, and total accumulated risk. Multivariable regression was used to study their associations with SES within each race/gender group. We found tracking of all seven risk factors: in each case, the cluster with the highest baseline value maintained its position as the highest-risk cluster over the next 10 years. After adjustment for age, lifestyle, and healthcare access, SES was associated inversely with baseline risk score in women (black and white), with risk change score in all four race/gender groups, and with accumulated risk score in women (black and white) and in white men. Our findings suggest that individuals with high overall cardiovascular risk in midlife can be identified by their relatively higher values of risk factors in younger ages and that socioeconomic differences in cardiovascular risk start accumulating early in life.     

Prevalence of traditional and novel markers of cardiovascular disease risk in Scottish adolescents: socioeconomic effects

Information on the health status and physical activity of Scottish adolescents is limited. This study examines the prevalence of cardiovascular disease (CVD) risk in Scottish adolescents by socioeconomic status (SES). Participants were recruited from two high schools that differed in the SES of the students in attendance. The sample included 73 boys and 34 girls (16.4 ± 0.6 years). Variables included anthropometry, physical activity, physical fitness, blood pressure, diet, and 11 metabolic markers of CVD risk. Significant sex differences (P ≤ 0.01) were noted for stature, waist circumference, waist-hip ratio, physical activity, cardiorespiratory fitness, muscular power, sprint speed, and several CVD risk factors: high-density lipoprotein (HDL), low-density lipoprotein (LDL), interleukin-6 (IL-6), and C-reactive protein (CRP) levels. Boys from a lower SES had significantly higher levels of glucose and plasminogen activator inhibitor-1 (PAI-1) but lower levels of adiponectin compared with boys from a higher SES. Girls from a lower SES had significantly (P ≤ 0.01) higher glucose and PAI-1 levels but lower levels of insulin and adiponectin than girls from a higher SES. High fat diets, low physical activity levels, and elevated CRP and total cholesterol levels were the CVD risk factors most commonly identified as being at-risk levels in this cohort, regardless of sex or SES. SES differences were not consistently apparent, but several CVD risk factors were identified as elevated in this sample of adolescents, regardless of sex or SES.     

Racial/ethnic heterogeneity in the socioeconomic patterning of CVD risk factors: in the United States: the multi-ethnic study of atherosclerosis

Many studies document racial variation, gender differences, and socioeconomic status (SES) patterning in cardiovascular disease (CVD) risk factors but few studies have investigated heterogeneity in SES differences by race/ethnicity or gender. Using data from the Multi-Ethnic Study of Atherosclerosis (N=6,814) and stratified regression models, we investigated race/ethnic differences in the SES patterning of diabetes, hypertension, smoking, and body mass index (BMI). Inverse socioeconomic gradients in hypertension, diabetes, smoking, and BMI were observed in White and Black women but associations were weaker or absent in Hispanic and Chinese women (except in the case of diabetes for Hispanic women). Even greater heterogeneity in social patterning of risk factors was observed in men. In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income. The inverse socioeconomic patterning was much less consistent in men of other races/ethnic groups, and higher SES was associated with higher BMI in non-White men. These findings have implications for understanding the causes of social patterning, for the analysis of SES adjusted race/ethnic differences, and for the targeting of interventions.     

Lifecourse socioeconomic trajectories and C-reactive protein levels in young adults: Findings from a Brazilian birth cohort

Socioeconomic factors are associated with cardiovascular disease. C-reactive protein (CRP) is increasingly implicated as a candidate linking conventional risk factors and atherosclerosis. The impact of early- and later-life socioeconomic status (SES) on CRP levels has not been widely investigated and a handful of studies from high-income countries are inconsistent. We set out to examine the associations between lifecourse socioeconomic indicators (family income at birth, maternal education, family income at age 23 and own education) on CRP levels in young adults belonging to the 1982 Pelotas (Brazil) Birth Cohort Study (n = 5914). Early-life SES showed significant and graded associations with CRP levels at age 23 independently of later SES. For example, men with higher family income at birth showed higher CRP levels at age 23 (p = 0.001 for trend) and women with less educated mothers showed higher CRP levels (p = 0.01 for trend). Notably, differential directions of association between SES indicators and CRP levels between men and women were found. When adjusted for SES at age 23, men with the lowest family income at birth showed 42% lower CRP levels when compared to men in the highest family income group (−42; 95% CI: -60,-16). In contrast women born to the least educated mothers had the highest CRP levels (35; 95% CI -2, 86). In both sexes, adiposity accounted for the overwhelming majority of the associations between SES and CRP levels. Sex and gender roles specific to middle-income countries, socio-cultural and environmental conditions that may impact adiposity, and the level of epidemiological transition may be key factors that are linked to the associations between lifecourse SES and CRP levels. Public health strategies aimed at decreasing the burden of cardiovascular disease in middle-income settings, in addition to highlighting the risks associated with adult obesity, should not overlook the wide-ranging impacts of lifecourse social determinants.     

Association between childhood socioeconomic status and coronary heart disease risk among postmenopausal women: findings from the British Women's Heart and Health Study

OBJECTIVES: We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women. METHODS: We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years. RESULTS: There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking. CONCLUSIONS: The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors.     

Socioeconomic status and cardiovascular disease among men: the Korean national health service prospective cohort study

OBJECTIVES: We examined the association between socioeconomic status (SES) and myocardial infarction and stroke subtypes, including the possible mediating influence of cardiovascular risk factors. METHODS: We evaluated data on 578756 Korean male public servants aged 30 to 58 years from August 1, 1990, to July 31, 2001. RESULTS: SES had inverse associations with mortality because of myocardial infarction and stroke subtypes, which were not changed by an adjustment for, or stratification by, cardiovascular risk factors. For nonfatal events, SES had positive, null, and inverse associations with myocardial infarction, ischemic stroke, and hemorrhagic stroke, respectively. The association between SES and nonfatal myocardial infarction depended on the presence of risk factors and was positive only among men who had cardiovascular risk factors. Case-fatality after hospital admission for cardiovascular diagnoses was significantly lower among higher SES groups, even after risk factor adjustment. CONCLUSIONS: Inverse SES associations with cardiovascular diseases were not mediated by cardiovascular risk factors among men who were undergoing economic transition. Socioeconomically patterned access to medical care may partly explain these socioeconomic gradients.     

Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension

The association between socio-economic status (SES) and untreated hypertension varies according to a country's level of development and racial/ethnic group. We sought to confirm this variation in women from China and the United States (US) as well as to investigate the impact of SES on several mediating risk factors. We also investigate the extent to which SES explains racial/ethnic differences in untreated hypertension in the US. We used cross-sectional data from 1814 non-pregnant women in China (China Health and Nutrition Survey (CHNS), 1997) and 3266 non-pregnant women in the United States (National Health and Nutrition Examination Survey (NHANES III), 1988-1994) respectively. A variety of statistical modelling techniques was used to predict untreated hypertension as a function of several mediating factors and to simulate the impact of changes in SES. The age-adjusted prevalence of untreated hypertension was significantly higher (p<0.01) for low-income White and Black women compared to Mexican American or Chinese women. Untreated hypertension was not significantly associated with income or education in Mexican Americans or women in China. Obesity and light physical activity had the largest mediating effect on the association between SES and untreated hypertension for all racial/ethnic groups. However, this effect was not as strong as the proxy effect of income and education. SES did not completely explain racial/ethnic differences in hypertension in the US. While SES was more strongly associated with hypertension in Blacks than Whites, Blacks were still 1.97 (95% CI 1.47-2.64) times more likely to have untreated hypertension than Whites after adjusting for SES differences. The association between SES and untreated hypertension varied by country and racial/ethnic group. An important explanation for this variation was the differential effect of SES on mediating risk factors. SES disparities between Whites and Blacks in the US partly explain differences in the prevalence of untreated hypertension between these racial/ethnic groups.     

Socioeconomic status and cardiovascular risk factors in the Czech Republic

BACKGROUND: In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and magnitude of the socioeconomic gradient in cardiovascular risk factors in a former communist country. As the relationship between material conditions and education has been much weaker than in the west, we have also attempted to separate their effects. METHODS: A cross-sectional survey examined a random sample of men and women resident in six Czech districts participating in the MONICA study in 1992. Participants completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided a blood sample. Two indicators of SES were used: education and material conditions, the indicator constructed from car ownership and crowding. Linear regression was employed to analyse the relation between SES and total and high-density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height. Logistic regression was used to assess the association between SES and smoking and hypertension. RESULTS: A total of 1141 men and 1212 women (overall response rate 75%) participated in the study. After controlling for age, all risk factors were associated with education, except HDL cholesterol in women and BMI in men; only smoking in both sexes and WHR in women and height in men were significantly related to material conditions. In mutually adjusted analyses, educational gradients persisted but associations with material conditions disappeared or became substantially weaker. The magnitude of the educational differences was similar to those found in western countries. CONCLUSIONS: Socioeconomic differences in cardiovascular risk factors in Czech Republic in 1992 had the same direction and similar magnitude as in Western Europe, and were strongly related to education rather than material conditions. Materialist explanations for the social differences seem unlikely in this population.     

Red blood cell docosahexaenoic acid and eicosapentaenoic acid concentrations are positively associated with socioeconomic status in patients with established coronary artery disease: data from the Heart and Soul Study

Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.