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

Gallo, Valentina; Mackenbach, Johan P.; Ezzati, Majid; Menvielle, Gwenn; Kunst, Anton E.; Rohrmann, Sabine; Kaaks, Rudolf; Teucher, Birgit; Boeing, Heiner and Bergmann, Manuela M., et al. (2012) In PLoS ONE 7(7).
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 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)... (More)
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. (Less)
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PLoS ONE
volume
7
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7
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Public Library of Science
external identifiers
  • wos:000306806600002
  • scopus:84864656027
ISSN
1932-6203
DOI
10.1371/journal.pone.0039013
language
English
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yes
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0a6d5de5-140e-492f-8dd5-cdf16b23a1dc (old id 3188127)
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2012-12-03 07:08:54
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2017-11-12 03:41:00
@article{0a6d5de5-140e-492f-8dd5-cdf16b23a1dc,
  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 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.},
  author       = {Gallo, Valentina and Mackenbach, Johan P. and Ezzati, Majid and Menvielle, Gwenn and Kunst, Anton E. and Rohrmann, Sabine and Kaaks, Rudolf and Teucher, Birgit and Boeing, Heiner and Bergmann, Manuela M. and Tjonneland, Anne and Dalton, Susanne O. and Overvad, Kim and Redondo, Maria-Luisa and Agudo, Antonio and Daponte, Antonio and Arriola, Larraitz and Navarro, Carmen and Barricante Gurrea, Aurelio and Khaw, Kay-Tee and Wareham, Nick and Key, Tim and Naska, Androniki and Trichopoulou, Antonia and Trichopoulos, Dimitrios and Masala, Giovanna and Panico, Salvatore and Contiero, Paolo and Tumino, Rosario and Bueno-de-Mesquita, H. Bas and Siersema, Peter D. and Peeters, Petra P. and Zackrisson, Sophia and Almquist, Martin and Eriksson, Sture and Hallmans, Goran and Skeie, Guri and Braaten, Tonje and Lund, Eiliv and Illner, Anne-Kathrin and Mouw, Traci and Riboli, Elio and Vineis, Paolo},
  issn         = {1932-6203},
  language     = {eng},
  number       = {7},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {Social Inequalities and Mortality in Europe - Results from a Large Multi-National Cohort},
  url          = {http://dx.doi.org/10.1371/journal.pone.0039013},
  volume       = {7},
  year         = {2012},
}