Social Inequalities and Mortality in Europe - Results from a Large Multi-National Cohort

Autor: Gallo, Valentina Mackenbach, Johan P. Ezzati, Majid and Menvielle, Gwenn Kunst, Anton E. Rohrmann, Sabine Kaaks, Rudolf Teucher, Birgit Boeing, Heiner Bergmann, Manuela M. and Tjonneland, Anne Dalton, Susanne O. Overvad, Kim and Redondo, Maria-Luisa Agudo, Antonio Daponte, Antonio and Arriola, Larraitz Navarro, Carmen Barricante Gurrea, Aurelio and Khaw, Kay-Tee Wareham, Nick Key, Tim Naska, Androniki and Trichopoulou, Antonia Trichopoulos, Dimitrios Masala, Giovanna and Panico, Salvatore Contiero, Paolo Tumino, Rosario and Bueno-de-Mesquita, H. Bas Siersema, Peter D. Peeters, Petra P. and Zackrisson, Sophia Almquist, Martin Eriksson, Sture and Hallmans, Goran Skeie, Guri Braaten, Tonje Lund, Eiliv and Illner, Anne-Kathrin Mouw, Traci Riboli, Elio Vineis, Paolo
Jazyk: angličtina
Rok vydání: 2012
Popis: 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 socioeconomic 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.
Databáze: OpenAIRE