Pixabay

Heart disease isa leading cause of death worldwide对于男人和女人。许多观察性研究表明，人们的社会经济地位因心脏病的风险存在不平等，也就是说，比具有较高社会经济地位的人相比，社会经济状况较低的人患心脏病的风险更高。

However, relatively few studies have looked at social inequalities in heart disease risk for women in the UK. The百万妇女研究provided a good opportunity to examine social inequalities in heart disease risk as well as to examine how much could be attributed to differences in health behaviours.

这项百万妇女研究是对妇女健康的一项大型观察研究，涉及超过50岁及以上的100万英国妇女。它主要由英国医学研究委员会和英国癌症研究所资助。它包括1930年代和1940年代出生的四分之一的英国妇女，她们是第一代substantial proportion smoked for their entire adult lives.

During 12 years follow-up of 1.2 million women without prior heart disease,72,000心脏病. These large numbers made it possible for us to look in detail at the risks of heart disease for women with varying levels of educational achievement, as well as for women living in areas with different levels of deprivation.

Using information on health behaviours (smoking, physical activity, alcohol consumption and body mass index), that women reported when they joined the study, we were able to look carefully at whether the differences in risk of heart disease were due to differences in health behaviours. Although body mass index is not a behaviour, we refer to it here as one because it is largely a marker of behaviours such as dietary intake and physical inactivity.

心脏病风险的不平等

In analyses which did not take account of health behaviours, women with lower levels of education were about twice as likely to develop heart disease or die from it than women with college or University degrees. A similar disparity was found (again in analyses which did not take account of health behaviours) between women living in the most deprived areas compared to women in the least deprived.

Smoking, lack of exercise and obesity are major risk factors for heart disease and are known to bemore common in people of lower socio-economic status, which we also found in this study. Overall alcohol consumption was low in this cohort; it was slightly higher in the least deprived but an average consumption of alcohol was about one unit per day.

Half of inequality due to smoking

主要目的our work是为了评估这四种健康行为可以解释心脏病风险的社会不平等，特别是因为以前的研究产生了对健康行为贡献的不同估计。

We found that most of the social inequalities in heart disease risk were attributable to differences in health behaviours. Smoking alone accounted for about half of the associations of heart disease with education and deprivation, and all four factors together accounted for some 70-80% of the associations.

这四种健康行为的真正贡献甚至更大，因为在女性加入研究时仅报告一次。我们无法考虑随着时间的推移生活方式的改变，例如戒烟在社会经济地位较高的妇女中更常见. This would mean we may well be underestimating how much smoking and the other factors have contributed to social inequalities in heart disease.

Implications

Overall, it is reasonable to conclude that most, if not all, of the social inequalities in heart disease incidence and mortality in these UK women could be explained by health behaviours. This is consistent with a growing body of evidence suggesting that health behaviours couldaccount for much of the social inequalities in disease risk.

但是，重要的是要认识到这些健康行为本身受教育和剥夺的影响，并且如果您没有资源来做到这一点，就很难改变它们。

我们的结果强调了现有的公共卫生政策对减少吸烟和促进健康饮食和运动的重要性。社会上较不利的成员通常是最难达到的，但是这项研究的发现强调了如果达到心脏病的降低率可能会带来的潜在收益。