Dataset Information

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.

SUBMITTER: Gallo V

PROVIDER: S-EPMC3405077 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Social inequalities and mortality in Europe--results from a large multi-national cohort.

Gallo Valentina V Mackenbach Johan P JP Ezzati Majid M Menvielle Gwenn G Kunst Anton E AE Rohrmann Sabine S Kaaks Rudolf R Teucher Birgit B Boeing Heiner H Bergmann Manuela M MM Tjønneland Anne A Dalton Susanne O SO Overvad Kim K Redondo Maria-Luisa ML Agudo Antonio A Daponte Antonio A Arriola Larraitz L Navarro Carmen C Gurrea Aurelio Barricante AB Khaw Kay-Tee KT Wareham Nick N Key Tim T Naska Androniki A Trichopoulou Antonia A Trichopoulos Dimitrios D Masala Giovanna G Panico Salvatore S Contiero Paolo P Tumino Rosario R Bueno-de-Mesquita H Bas HB Siersema Peter D PD Peeters Petra P PP Zackrisson Sophia S Almquist Martin M Eriksson Sture S Hallmans Göran G Skeie Guri G Braaten Tonje T Lund Eiliv E Illner Anne-Kathrin AK Mouw Traci T Riboli Elio E Vineis Paolo P

PloS one 20120725 7

<h4>Background</h4>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.<h4>Methods</h4>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 fr ...[more]

PMID: 22848347

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Project description:AimsSleep disturbances exhibit a strong social patterning, and inadequate sleep has been associated with adverse health outcomes, including cardiovascular disorders (CVD). However, the contribution of sleep to socioeconomic inequalities in CVD is unclear. This study pools data from eight European cohorts to investigate the role of sleep duration in the association between life-course socioeconomic status (SES) and CVD.Methods and resultsWe used cross-sectional data from eight European cohorts, totalling 111 205 participants. Life-course SES was assessed using father's and adult occupational position. Self-reported sleep duration was categorized into recommended (6-8.5 h/night), long (>8.5 h/night), and short (<6 h/night). We examined two cardiovascular outcomes: coronary heart disease (CHD) and stroke. Main analyses were conducted using pooled data and examined the association between life-course SES and CVD, and the contribution of sleep duration to this gradient using counterfactual mediation. Low father's occupational position was associated with an increased risk of CHD (men: OR = 1.19, 95% CI [1.04; 1.37]; women: OR = 1.25, 95% CI [1.02; 1.54]), with marginal decrease of the gradient after accounting for adult occupational position (men: OR = 1.17, 95% CI [1.02; 1.35]; women: OR = 1.22, 95% CI [0.99; 1.52]), and no mediating effect by short sleep duration. Low adult occupational position was associated with an increased risk of CHD in both men and women (men: OR = 1.48, 95% CI [1.14; 1.92]; women: OR = 1.53, 95% CI [1.04; 2.21]). Short sleep duration meaningfully contributed to the association between adult occupational position and CHD in men, with 13.4% mediation. Stroke did not exhibit a social patterning with any of the variables examined.ConclusionThis study suggests that inadequate sleep accounts to a meaningful proportion of the association between adult occupational position and CHD, at least in men. With sleep increasingly being considered an important cardiovascular risk factor in its own terms, our study additionally points to its potential role in social inequalities in cardiovascular disease.

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Dataset Information

Social inequalities and mortality in Europe--results from a large multi-national cohort.

Background

Methods

Results

Discussion

Publications

Social inequalities and mortality in Europe--results from a large multi-national cohort.

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