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Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

ABSTRACT: BACKGROUND:Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors. METHODS:Data were from seven cohort studies participating in the LIFEPATH Consortium (total n?=?179?090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education. RESULTS:Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5?years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest. CONCLUSIONS:These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.

SUBMITTER: Laine JE

PROVIDER: S-EPMC7266549 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

Laine Jessica E JE Baltar Valéria T VT Stringhini Silvia S Gandini Martina M Chadeau-Hyam Marc M Kivimaki Mika M Severi Gianluca G Perduca Vittorio V Hodge Allison M AM Dugué Pierre-Antoine PA Giles Graham G GG Milne Roger L RL Barros Henrique H Sacerdote Carlotta C Krogh Vittorio V Panico Salvatore S Tumino Rosario R Goldberg Marcel M Zins Marie M Delpierre Cyrille C Vineis Paolo P

International journal of epidemiology 20200401 2

<h4>Background</h4>Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors.<h4>Methods</h4>Data were from seven cohort studies participating ...[more]

PMID: 31855265

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Project description:Background and aimsWhen measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time.DesignCause-deleted life table analysis of national mortality records.SettingEngland and Wales, 2001-16.CasesAll-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD).MeasurementsLife expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'.FindingsIn 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.ConclusionsDeaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.

Project description:BackgroundThe prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds and putting undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy, and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence and determinants of excess weight inequalities in their local population.MethodsWe conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults (N = 6,387). We used the Corrected Concentration Index (CCI) to measure absolute inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality.ResultsAt a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, as measured by the CCI, with educational qualification ranking first [CCI: -0.090, p < 0.01], closely followed by neighbourhood-level deprivation [CCI: -0.050, p < 0.01]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution.ConclusionsWhile socio-economic inequalities in excess weight exist in the English adult population, our findings underscore the importance of considering multiple dimensions of deprivation and the unique needs of different populations when developing policies to address overweight and obesity. Targeted interventions for adults with overweight and obesity with long-lasting illnesses and women can generate both short-term and long-term economic benefits, by reducing healthcare costs and increasing workforce productivity.

Project description:IntroductionThe socio-economic circumstances and health of people with disabilities has been relatively ignored in public health research, policy and practice in Australia and internationally. This is despite emerging evidence that the socio-economic circumstances that people with disabilities live in contributes to their poorer health. Compared to other developed countries, Australians with disabilities are more likely to live in disadvantaged circumstances, despite being an economically prosperous country; it is therefore likely that the socio-economic disadvantage experienced by Australians with disabilities makes a significant contribution to their health. Despite the importance of this issue Australia does not routinely monitor the socio-economic inequalities for people with disabilities. This paper addresses this gap by describing time trends in socio-economic conditions for Australians with and without disabilities according to the severity of the disability and sex.MethodsCross-sectional analyses of the Australian Bureau of Statistics Survey of Disability, Ageing and Carers were carried out at three time points (1998, 2003 and 2009) to estimate the proportions of women and men (aged between 25 and 64 years) who were living on low incomes, had not completed year 12, were not in paid work, living in private rental and experiencing multiple disadvantage (three or more of the indicators).ResultsPeople with disabilities are less likely to have completed year 12, be in paid work and are more likely to be living on low incomes and experiencing multiple disadvantage. These conditions worsened with increasing severity of disability and increased or persisted over time, with most of the increase between 1998 and 2003. While women with milder disabilities tended to fare worse than men, the proportions were similar for those with moderate and severe/profound disabilities.ConclusionPeople with disabilities experience high levels of socio-economic disadvantage which has increased or persisted over time and these are likely to translate into poorer health outcomes. A large proportion experience multiple forms of disadvantage, reinforcing the need to tackle disadvantage in a coordinated way across sectors.People with disabilities should be a priority population group for public health. Monitoring socio-economic conditions of people with disabilities is critical for informing policy and assessing the impact of disability reforms.

Dataset Information

Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

Publications

Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

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