不同世代心血管疾病的教育不平等及其中介因素:一项前瞻性队列研究。

IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Nana Wang, Xiaocan Jia, Zhixing Fan, Chaojun Yang, Yuping Wang, Jingwen Fan, Chenyu Zhao, Yongli Yang, Xuezhong Shi
{"title":"不同世代心血管疾病的教育不平等及其中介因素:一项前瞻性队列研究。","authors":"Nana Wang, Xiaocan Jia, Zhixing Fan, Chaojun Yang, Yuping Wang, Jingwen Fan, Chenyu Zhao, Yongli Yang, Xuezhong Shi","doi":"10.1093/ehjqcco/qcaf010","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to assess the educational inequalities in cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among four generations, and to analyse the mediating role of healthy lifestyles and metabolic factors.</p><p><strong>Methods and results: </strong>This prospective cohort study included 447 227 participants from UK Biobank, with a mean age of 56.10 (8.08) years, divided into four generations born in 1930s, 1940s, 1950s, and 1960s. Cox regression models and the relative index of inequality (RII) were employed to estimate educational inequality on CVD, CHD, and stroke. Counterfactual mediation analysis was utilized to estimate the mediating effects of healthy lifestyles and metabolic factors. After a median of 13.39 years follow-up, 81 470 cases of CVD were documented. In the fully adjusted model, compared to participants with college education, participants with primary school or below had hazard ratios [95% confidence interval (CI)] for CVD of 1.03 (0.96, 1.11), 1.05 (1.03, 1.08), 1.15 (1.10, 1.20), and 1.37 (1.25, 1.51) in 1930s, 1940s, 1950s, and 1960s, respectively. RII (95% Cl) in CVD increased from 1.04 (0.94,1.14) in the 1930s to 1.35(1.22,1.49) in the 1960s. Across all generations, the proportion mediated by healthy lifestyles and metabolic factors on CVD was 13.36-21.72% and 30.65-40.70%, respectively. Similar results were observed for CHD and stroke.</p><p><strong>Conclusion: </strong>Educational inequalities in CVD incidence persisted across generations, with potentially greater disparities in 1960s. Implementing effective interventions for healthy lifestyle and metabolic factors that target the less educated population may help reduce these health disparities.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"622-630"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Educational inequalities in cardiovascular diseases and their mediating factors across different generations: a prospective cohort study.\",\"authors\":\"Nana Wang, Xiaocan Jia, Zhixing Fan, Chaojun Yang, Yuping Wang, Jingwen Fan, Chenyu Zhao, Yongli Yang, Xuezhong Shi\",\"doi\":\"10.1093/ehjqcco/qcaf010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>This study aimed to assess the educational inequalities in cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among four generations, and to analyse the mediating role of healthy lifestyles and metabolic factors.</p><p><strong>Methods and results: </strong>This prospective cohort study included 447 227 participants from UK Biobank, with a mean age of 56.10 (8.08) years, divided into four generations born in 1930s, 1940s, 1950s, and 1960s. Cox regression models and the relative index of inequality (RII) were employed to estimate educational inequality on CVD, CHD, and stroke. Counterfactual mediation analysis was utilized to estimate the mediating effects of healthy lifestyles and metabolic factors. After a median of 13.39 years follow-up, 81 470 cases of CVD were documented. In the fully adjusted model, compared to participants with college education, participants with primary school or below had hazard ratios [95% confidence interval (CI)] for CVD of 1.03 (0.96, 1.11), 1.05 (1.03, 1.08), 1.15 (1.10, 1.20), and 1.37 (1.25, 1.51) in 1930s, 1940s, 1950s, and 1960s, respectively. RII (95% Cl) in CVD increased from 1.04 (0.94,1.14) in the 1930s to 1.35(1.22,1.49) in the 1960s. Across all generations, the proportion mediated by healthy lifestyles and metabolic factors on CVD was 13.36-21.72% and 30.65-40.70%, respectively. Similar results were observed for CHD and stroke.</p><p><strong>Conclusion: </strong>Educational inequalities in CVD incidence persisted across generations, with potentially greater disparities in 1960s. Implementing effective interventions for healthy lifestyle and metabolic factors that target the less educated population may help reduce these health disparities.</p>\",\"PeriodicalId\":11869,\"journal\":{\"name\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"volume\":\" \",\"pages\":\"622-630\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjqcco/qcaf010\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Quality of Care and Clinical Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ehjqcco/qcaf010","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

目的:本研究旨在评估四代人在心血管疾病(CVD)、冠心病(CHD)和脑卒中方面的教育不平等,并分析健康生活方式和代谢因素在其中的中介作用。方法:本前瞻性队列研究纳入来自UK Biobank的447227名参与者,平均年龄56.10(8.08)岁,分为4代,分别出生于20世纪30年代、40年代、50年代和60年代。采用Cox回归模型和相对不平等指数(relative index of inequality, RII)估计心血管疾病、冠心病和脑卒中的教育不平等。采用反事实中介分析方法估计健康生活方式和代谢因素的中介作用。结果:经过中位13.39年的随访,记录了81470例CVD病例。在完全调整模型中,与大学学历的受试者相比,小学及以下学历的受试者在30年代、40年代、50年代和60年代CVD的hr (95%Cl)分别为1.03(0.96,1.11)、1.05(1.03,1.08)、1.15(1.10,1.20)和1.37(1.25,1.51)。心血管疾病的RII (95%Cl)由20世纪30年代的1.04(0.94,1.14)上升到20世纪60年代的1.35(1.22,1.49)。在各代人中,健康生活方式和代谢因素对心血管疾病的影响分别为13.36% ~ 21.72%和30.65% ~ 40.70%。在冠心病和中风中也观察到类似的结果。结论:心血管疾病发病率的教育不平等在几代人之间持续存在,在20世纪60年代的差异可能更大。针对受教育程度较低的人群实施有效的健康生活方式和代谢因素干预措施,可能有助于缩小这些健康差距。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Educational inequalities in cardiovascular diseases and their mediating factors across different generations: a prospective cohort study.

Aims: This study aimed to assess the educational inequalities in cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among four generations, and to analyse the mediating role of healthy lifestyles and metabolic factors.

Methods and results: This prospective cohort study included 447 227 participants from UK Biobank, with a mean age of 56.10 (8.08) years, divided into four generations born in 1930s, 1940s, 1950s, and 1960s. Cox regression models and the relative index of inequality (RII) were employed to estimate educational inequality on CVD, CHD, and stroke. Counterfactual mediation analysis was utilized to estimate the mediating effects of healthy lifestyles and metabolic factors. After a median of 13.39 years follow-up, 81 470 cases of CVD were documented. In the fully adjusted model, compared to participants with college education, participants with primary school or below had hazard ratios [95% confidence interval (CI)] for CVD of 1.03 (0.96, 1.11), 1.05 (1.03, 1.08), 1.15 (1.10, 1.20), and 1.37 (1.25, 1.51) in 1930s, 1940s, 1950s, and 1960s, respectively. RII (95% Cl) in CVD increased from 1.04 (0.94,1.14) in the 1930s to 1.35(1.22,1.49) in the 1960s. Across all generations, the proportion mediated by healthy lifestyles and metabolic factors on CVD was 13.36-21.72% and 30.65-40.70%, respectively. Similar results were observed for CHD and stroke.

Conclusion: Educational inequalities in CVD incidence persisted across generations, with potentially greater disparities in 1960s. Implementing effective interventions for healthy lifestyle and metabolic factors that target the less educated population may help reduce these health disparities.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信