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Educational inequalities in all-cause and cause-specific mortality among people with gout : a register-based matched cohort study in southern Sweden

Kiadaliri, Ali LU ; Moreno-Betancur, Margarita ; Turkiewicz, Aleksandra LU and Englund, Martin LU (2019) In International Journal for Equity in Health 18(1).
Abstract

BACKGROUND: Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden.

METHODS: We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998-2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference... (More)

BACKGROUND: Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden.

METHODS: We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998-2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: "underlying cause", "any mention", and "weighted multiple-cause".

RESULTS: Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach.

CONCLUSIONS: Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.

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author
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type
Contribution to journal
publication status
published
subject
in
International Journal for Equity in Health
volume
18
issue
1
article number
164
pages
10 pages
publisher
BioMed Central (BMC)
external identifiers
  • pmid:31660978
  • scopus:85074241513
ISSN
1475-9276
DOI
10.1186/s12939-019-1076-1
language
English
LU publication?
yes
id
ca37f5aa-9bda-4eb3-b00b-d0f4342b79ff
date added to LUP
2019-10-30 09:51:09
date last changed
2020-01-30 03:00:10
@article{ca37f5aa-9bda-4eb3-b00b-d0f4342b79ff,
  abstract     = {<p>BACKGROUND: Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden.</p><p>METHODS: We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998-2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: "underlying cause", "any mention", and "weighted multiple-cause".</p><p>RESULTS: Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach.</p><p>CONCLUSIONS: Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.</p>},
  author       = {Kiadaliri, Ali and Moreno-Betancur, Margarita and Turkiewicz, Aleksandra and Englund, Martin},
  issn         = {1475-9276},
  language     = {eng},
  month        = {10},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {International Journal for Equity in Health},
  title        = {Educational inequalities in all-cause and cause-specific mortality among people with gout : a register-based matched cohort study in southern Sweden},
  url          = {http://dx.doi.org/10.1186/s12939-019-1076-1},
  doi          = {10.1186/s12939-019-1076-1},
  volume       = {18},
  year         = {2019},
}