社会经济不平等与罹患身体疾病后心理和认知多病发展之间的关系:一项多队列研究。

IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
EClinicalMedicine Pub Date : 2024-07-25 eCollection Date: 2024-08-01 DOI:10.1016/j.eclinm.2024.102739
Yaguan Zhou, Mika Kivimäki, Lijing L Yan, Rodrigo M Carrillo-Larco, Yue Zhang, Yangyang Cheng, Hui Wang, Maigeng Zhou, Xiaolin Xu
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引用次数: 0

摘要

背景:慢性身体疾病(如心脏病、糖尿病)会随着人口老龄化而增加,并导致心理和认知方面的多重疾病。然而,人们对这一过程中的社会经济不平等却知之甚少。我们研究了社会经济地位(SES)与躯体疾病发生后心理和认知多重疾病进展之间的关系:我们使用了来自美国、欧洲和亚洲 24 个国家的五项前瞻性队列研究的统一个人水平数据,这些数据在 2002 年至 2021 年期间进行了重复发病率测量。我们对至少患有一种新发躯体疾病(高血压、糖尿病、心脏病、中风、慢性肺病、癌症或关节炎)的参与者进行了随访,以了解他们的躯体-心理多病症、躯体-认知多病症以及躯体-心理-认知多病症的进展情况。社会经济地位是根据发病时的教育水平和家庭总财富确定的。在按社会经济地位分层的分析中,对心理和认知多病进展的时间和发病率进行了估算。采用细灰子分布危险模型和多状态模型来估计社会经济地位与心理和认知多疾病进展之间的关系:在 20250 名年龄≥45 岁(身体疾病发病时的平均年龄为 65.38 岁,标准差为 8.37)、至少患有一种新发身体疾病的参与者中,有 7928 人(39.2%)在中位随访 8.0 年(168575 人年)期间发展为心理和认知多病症。低社会经济地位人群摆脱身体-心理-认知多病症的平均生存时间为 11.96 年(95% 置信区间为 11.57-12.34 年),而高社会经济地位人群为 15.52 年(15.40-15.63 年),相应的发病率分别为每千人年 18.44 例(16.32-20.82 例)和 3.15 例(2.48-4.01 例)。教育程度、家庭财富和社会经济地位与多病症的关系呈剂量依赖关系,社会经济地位每降低一个等级,身体-心理多病症的亚分布危险比为 1.24(1.19-1.29),身体-认知多病症的亚分布危险比为 1.47(1.40-1.54),身体-心理-认知多病症的亚分布危险比为 1.84(1.72-1.97)。在患有关节炎、高血压或糖尿病的参试者中,观察到的 SES 与多病症的关联性最强。在多州模型中,社会经济状况与从身体状况到身体-心理多病性、身体-认知多病性和身体-心理-认知多病性的所有五种转变都有关联:社会经济不平等与慢性躯体疾病的进展有关,社会经济地位较低的群体患心理和认知多病症的时间更早,发病率更高。这些研究结果表明,有必要制定更有效的公平导向政策和医疗保健措施,以解决社会经济地位较低且身体状况较差的人群心理健康和认知能力下降的问题:浙江大学 "百人计划 "科研启动基金、中央高校基础研究基金、惠康基金会、医学研究理事会、芬兰国家老龄化研究所、芬兰科学院。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associations between socioeconomic inequalities and progression to psychological and cognitive multimorbidities after onset of a physical condition: a multicohort study.

Background: Chronic physical conditions (e.g., heart diseases, diabetes) increase with population ageing, contributing to psychological and cognitive multimorbidities. Yet, little is known about socioeconomic inequalities in this process. We examined the associations between socioeconomic status (SES) and progression to psychological and cognitive multimorbidities after onset of a physical condition.

Methods: We used harmonized individual-level data from five prospective cohort studies across 24 countries in the US, Europe and Asia, with repeated morbidity measurements between 2002 and 2021. Participants with at least one new-onset physical conditions (hypertension, diabetes, heart diseases, stroke, chronic lung diseases, cancer, or arthritis) were followed up for progression to physical-psychological multimorbidity, physical-cognitive multimorbidity, and physical-psychological-cognitive multimorbidity. SES was determined based on educational level and total household wealth at the onset of a physical condition. Time to and incidence rates of progressing psychological and cognitive multimorbidities were estimated in analyses stratified by SES. Fine-Gray subdistribution hazard models and multi-state models were used to estimate the associations between SES and progression to psychological and cognitive multimorbidities.

Findings: Among 20,250 participants aged ≥45 years (mean age at a physical condition onset 65.38 years, standard deviation 8.37) with at least one new-onset physical conditions in the analysis, 7928 (39.2%) progressed to psychological and cognitive multimorbidities during a median follow-up of 8.0 years (168,575 person-years). The mean survival time free from physical-psychological-cognitive multimorbidity was 11.96 years (95% confidence interval 11.57-12.34) in low SES individuals, compared to 15.52 years (15.40-15.63) in high SES individuals, with the corresponding incidence rate of 18.44 (16.32-20.82) and 3.15 (2.48-4.01) per 1000 person-years, respectively. The associations of education, household wealth and SES with multimorbidities followed a dose-dependent relation, with subdistribution hazard ratios per decreasing SES category being 1.24 (1.19-1.29) for physical-psychological multimorbidity, 1.47 (1.40-1.54) for physical-cognitive multimorbidity, and 1.84 (1.72-1.97) for physical-psychological-cognitive multimorbidity. The strongest SES-multimorbidities associations were observed in participants with arthritis, hypertension or diabetes. In multi-state models SES was linked to all five transitions from physical condition to physical-psychological multimorbidity, physical-cognitive multimorbidity and physical-psychological-cognitive multimorbidity.

Interpretation: Socioeconomic inequalities are associated with the progression of a chronic physical condition, with the lower SES groups had both an earlier time to and a higher incidence of psychological and cognitive multimorbidities. These findings underscore the need for more effective equity-oriented policies and healthcare practices to address reduced psychological wellness and cognitive maintenance among individuals with low SES and physical conditions.

Funding: Zhejiang University Hundred Talents Program Research Initiation Fund, Fundamental Research Funds for the Central Universities in China, Wellcome Trust, Medical Research Council, National Institute on Aging, Academy of Finland.

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来源期刊
EClinicalMedicine
EClinicalMedicine Medicine-Medicine (all)
CiteScore
18.90
自引率
1.30%
发文量
506
审稿时长
22 days
期刊介绍: eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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