Social inequalities and mortality in Europe--results from a large multi-national cohort
- PMID:22848347
- PMCID: PMC3405077
- DOI: 10.1371/journal.pone.0039013
Social inequalities and mortality in Europe--results from a large multi-national cohort
Abstract
Background: Socio-economic inequalities in mortality are observed at the country level in both North America and Europe. The purpose of this work is to investigate the contribution of specific risk factors to social inequalities in cause-specific mortality using a large multi-country cohort of Europeans.
Methods: A total of 3,456,689 person/years follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) was analysed. Educational level of subjects coming from 9 European countries was recorded as proxy for socio-economic status (SES). Cox proportional hazard model's with a step-wise inclusion of explanatory variables were used to explore the association between SES and mortality; a Relative Index of Inequality (RII) was calculated as measure of relative inequality.
Results: Total mortality among men with the highest education level is reduced by 43% compared to men with the lowest (HR 0.57, 95% C.I. 0.52-0.61); among women by 29% (HR 0.71, 95% C.I. 0.64-0.78). The risk reduction was attenuated by 7% in men and 3% in women by the introduction of smoking and to a lesser extent (2% in men and 3% in women) by introducing body mass index and additional explanatory variables (alcohol consumption, leisure physical activity, fruit and vegetable intake) (3% in men and 5% in women). Social inequalities were highly statistically significant for all causes of death examined in men. In women, social inequalities were less strong, but statistically significant for all causes of death except for cancer-related mortality and injuries.
Discussion: In this European study, substantial social inequalities in mortality among European men and women which cannot be fully explained away by accounting for known common risk factors for chronic diseases are reported.
Conflict of interest statement
Figures
Similar articles
- The role of smoking and diet in explaining educational inequalities in lung cancer incidence.Menvielle G, Boshuizen H, Kunst AE, Dalton SO, Vineis P, Bergmann MM, Hermann S, Ferrari P, Raaschou-Nielsen O, Tjønneland A, Kaaks R, Linseisen J, Kosti M, Trichopoulou A, Dilis V, Palli D, Krogh V, Panico S, Tumino R, Büchner FL, van Gils CH, Peeters PH, Braaten T, Gram IT, Lund E, Rodriguez L, Agudo A, Sánchez MJ, Tormo MJ, Ardanaz E, Manjer J, Wirfält E, Hallmans G, Rasmuson T, Bingham S, Khaw KT, Allen N, Key T, Boffetta P, Duell EJ, Slimani N, Gallo V, Riboli E, Bueno-de-Mesquita HB.Menvielle G, et al.J Natl Cancer Inst. 2009 Mar 4;101(5):321-30. doi: 10.1093/jnci/djn513. Epub 2009 Feb 24.J Natl Cancer Inst. 2009.PMID:19244178Free PMC article.
- Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort.McFadden E, Luben R, Wareham N, Bingham S, Khaw KT.McFadden E, et al.Eur J Epidemiol. 2008;23(8):511-22. doi: 10.1007/s10654-008-9267-x. Epub 2008 Jun 14.Eur J Epidemiol. 2008.PMID:18553139
- What's the difference? A gender perspective on understanding educational inequalities in all-cause and cause-specific mortality.van Hedel K, van Lenthe FJ, Oude Groeniger J, Mackenbach JP.van Hedel K, et al.BMC Public Health. 2018 Sep 10;18(1):1105. doi: 10.1186/s12889-018-5940-5.BMC Public Health. 2018.PMID:30200912Free PMC article.
- The contribution of material, psychosocial, and behavioral factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: relative and absolute perspectives.Khang YH, Lynch JW, Yang S, Harper S, Yun SC, Jung-Choi K, Kim HR.Khang YH, et al.Soc Sci Med. 2009 Mar;68(5):858-66. doi: 10.1016/j.socscimed.2008.12.003. Epub 2009 Jan 2.Soc Sci Med. 2009.PMID:19121885
- Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up.Kamphuis CB, Turrell G, Giskes K, Mackenbach JP, van Lenthe FJ.Kamphuis CB, et al.BMC Public Health. 2012 Dec 5;12:1045. doi: 10.1186/1471-2458-12-1045.BMC Public Health. 2012.PMID:23217053Free PMC article.
Cited by
- The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare.Ultee KHJ, Tjeertes EKM, Bastos Gonçalves F, Rouwet EV, Hoofwijk AGM, Stolker RJ, Verhagen HJM, Hoeks SE.Ultee KHJ, et al.PLoS One. 2018 Jan 22;13(1):e0191464. doi: 10.1371/journal.pone.0191464. eCollection 2018.PLoS One. 2018.PMID:29357383Free PMC article.
- Adverse childhood experiences and physiological wear-and-tear in midlife: Findings from the 1958 British birth cohort.Barboza Solís C, Kelly-Irving M, Fantin R, Darnaudéry M, Torrisani J, Lang T, Delpierre C.Barboza Solís C, et al.Proc Natl Acad Sci U S A. 2015 Feb 17;112(7):E738-46. doi: 10.1073/pnas.1417325112. Epub 2015 Feb 2.Proc Natl Acad Sci U S A. 2015.PMID:25646470Free PMC article.
- Adverse childhood experiences and premature all-cause mortality.Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C.Kelly-Irving M, et al.Eur J Epidemiol. 2013 Sep;28(9):721-34. doi: 10.1007/s10654-013-9832-9. Epub 2013 Jul 26.Eur J Epidemiol. 2013.PMID:23887883Free PMC article.
- Combining individual and aggregated data to investigate the role of socioeconomic disparities on cancer burden in Italy.Mezzetti M, Palli D, Dominici F.Mezzetti M, et al.Stat Med. 2020 Jan 15;39(1):26-44. doi: 10.1002/sim.8392. Epub 2019 Nov 20.Stat Med. 2020.PMID:31746020Free PMC article.
- Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study.Kelly-Irving M, Lepage B, Dedieu D, Lacey R, Cable N, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C.Kelly-Irving M, et al.BMC Public Health. 2013 Aug 19;13:767. doi: 10.1186/1471-2458-13-767.BMC Public Health. 2013.PMID:23957659Free PMC article.
References
- Marmot M, Friel S, Bell R, Houweling TA, Taylor S (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 372(9650): 1661–9. - PubMed
- Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, et al. (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23): 2468–81. - PubMed
- Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ (1997) Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet 349(9066): 1655–9. - PubMed