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Ohm E, Madsen C, Gravseth HM, Brage S, Grøholt EK, Alver K, Holvik K. Post-injury long-term sickness absence and risk of disability pension: The role of socioeconomic status. Injury 2024; 55:111480. [PMID: 38452702 DOI: 10.1016/j.injury.2024.111480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway. MATERIALS AND METHODS We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence. RESULTS Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders. CONCLUSIONS The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.
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Affiliation(s)
- Eyvind Ohm
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway.
| | - Christian Madsen
- Department of Disease Burden, Norwegian Institute of Public Health, Zander Kaaesgt. 7 5015 Bergen, Norway
| | - Hans Magne Gravseth
- Department of Occupational Health Surveillance, National Institute of Occupational Health, PO Box 5330 Majorstuen 0304 Oslo, Norway
| | - Søren Brage
- Retired medical doctor with a PhD in epidemiology/social medicine. Before retirement SB held a position in the Norwegian Labour and Welfare Administration, leading the unit responsible for medical coding of welfare benefits from 1998 to 2015
| | - Else Karin Grøholt
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Kari Alver
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
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McKay GJ, Lyner N, Linden GJ, Kee F, Moitry M, Biasch K, Amouyel P, Dallongeville J, Bongard V, Ferrières J, Gey KF, Patterson CC, Woodside JV. Association of low plasma antioxidant levels with all-cause mortality and coronary events in healthy middle-aged men from France and Northern Ireland in the PRIME study. Eur J Nutr 2021; 60:2631-2641. [PMID: 33355688 PMCID: PMC8275518 DOI: 10.1007/s00394-020-02455-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The main underlying risk factors associated with coronary heart disease (CHD) are modifiable and oxidative injury and systemic inflammatory damage represent key aetiological factors associated with the development and progression of CHD and premature mortality. OBJECTIVE To examine associations of plasma antioxidant status with all-cause mortality and fatal or non-fatal cardiovascular events. DESIGN The PRIME study prospectively evaluated 9709 men aged 50-59 years between 1991 and 1993 in Northern Ireland and France who were free of CHD at recruitment and followed annually for deaths and cardiovascular events for 10 years. Serum concentrations of vitamin C, retinol, two forms of vitamin E (α- and γ-tocopherol) and six carotenoids were quantified by high-performance liquid chromatography. Baseline conventional risk factors were considered, as well as socioeconomic differences and lifestyle behaviours including diet, smoking habit, physical activity, and alcohol consumption through Cox regression analyses. RESULTS At 10 years, there were 538 deaths from any cause and 440 fatal or non-fatal cardiovascular events. After adjustment for country, age, systolic blood pressure, diabetes, body mass index, cholesterol, high density lipoprotein cholesterol, triglycerides, height, total physical activity, alcohol consumption and smoking habit, higher levels of all antioxidants were associated with significantly lower risk of all-cause mortality, with the exception of γ-tocopherol. Only retinol was significantly associated with decreased risk of cardiovascular events in a fully adjusted model. CONCLUSIONS Low antioxidant levels contribute to the gradient of all-cause mortality and cardiovascular incidence independent of lifestyle behaviours and traditional cardiovascular and socioeconomic risk factors.
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Affiliation(s)
- Gareth J McKay
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK.
| | - Natalie Lyner
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Gerry J Linden
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Frank Kee
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK
| | | | | | | | | | | | | | - K Fred Gey
- The MONICA Reference Centre for Vitamins, Department of Biochemistry and Molecular Biology, University of Bern, Bern, Switzerland
| | - Chris C Patterson
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Jayne V Woodside
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, UK
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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Ultee KHJ, Tjeertes EKM, Bastos Gonçalves F, Rouwet EV, Hoofwijk AGM, Stolker RJ, Verhagen HJM, Hoeks SE. The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare. PLoS One 2018; 13:e0191464. [PMID: 29357383 PMCID: PMC5777644 DOI: 10.1371/journal.pone.0191464] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 01/05/2018] [Indexed: 11/19/2022] Open
Abstract
Background The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. Methods Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES–quantified by gross household income–with major 30-day complications and long-term postoperative survival. Results A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01–1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08–2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07–1.48, first income quartile: HR: 3.10, 95% CI: 1.04–9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. Conclusions Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.
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Affiliation(s)
- Klaas H. J. Ultee
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elke K. M. Tjeertes
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frederico Bastos Gonçalves
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ellen V. Rouwet
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Robert Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hence J. M. Verhagen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sanne E. Hoeks
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- * E-mail:
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Appleton KM, Woodside JV, Arveiler D, Haas B, Amouyel P, Montaye M, Ferrieres J, Ruidavets JB, Yarnell JWG, Kee F, Evans A, Bingham A, Ducimetiere P, Patterson CC. A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study. Ann Behav Med 2017; 50:582-91. [PMID: 26979997 PMCID: PMC4933737 DOI: 10.1007/s12160-016-9784-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits. Purpose These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality. Methods Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support. Results Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption. Conclusions These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.
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Affiliation(s)
- K M Appleton
- Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK.
| | - J V Woodside
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - D Arveiler
- Department of Epidemiology and Public Health, University of Strasbourg, EA3430, Strasbourg, France
| | - B Haas
- Department of Epidemiology and Public Health, University of Strasbourg, EA3430, Strasbourg, France
| | - P Amouyel
- The Lille Monica Project, INSERM U744, Lille, France
| | - M Montaye
- The Lille Monica Project, INSERM U744, Lille, France
| | - J Ferrieres
- The Toulouse MONICA Project, INSERM UMR1027, Toulouse, France
| | - J B Ruidavets
- The Toulouse MONICA Project, INSERM UMR1027, Toulouse, France
| | - J W G Yarnell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - F Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - A Evans
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - A Bingham
- The Coordinating Center, INSERM U780, Hôpital Paul Brousse, Villejuif, France
| | - P Ducimetiere
- The Coordinating Center, INSERM U780, Hôpital Paul Brousse, Villejuif, France
| | - C C Patterson
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
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Simon PHG, Sylvestre MP, Tremblay J, Hamet P. Key Considerations and Methods in the Study of Gene-Environment Interactions. Am J Hypertens 2016; 29:891-9. [PMID: 27037711 DOI: 10.1093/ajh/hpw021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/08/2016] [Indexed: 12/16/2022] Open
Abstract
With increased involvement of genetic data in most epidemiological investigations, gene-environment (G × E) interactions now stand as a topic, which must be meticulously assessed and thoroughly understood. The level, mode, and outcomes of interactions between environmental factors and genetic traits have the capacity to modulate disease risk. These must, therefore, be carefully evaluated as they have the potential to offer novel insights on the "missing heritability problem", reaching beyond our current limitations. First, we review a definition of G × E interactions. We then explore how concepts such as the early manifestation of the genetic components of a disease, the heterogeneity of complex traits, the clear definition of epidemiological strata, and the effect of varying physiological conditions can affect our capacity to detect (or miss) G × E interactions. Lastly, we discuss the shortfalls of regression models to study G × E interactions and how other methods such as the ReliefF algorithm, pattern recognition methods, or the LASSO (Least Absolute Shrinkage and Selection Operator) method can enable us to more adequately model G × E interactions. Overall, we present the elements to consider and a path to follow when studying genetic determinants of disease in order to uncover potential G × E interactions.
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Affiliation(s)
- Paul H G Simon
- CHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-Pierre Sylvestre
- CHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Johanne Tremblay
- CHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pavel Hamet
- CHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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Veronesi G, Ferrario MM, Kuulasmaa K, Bobak M, Chambless LE, Salomaa V, Soderberg S, Pajak A, Jørgensen T, Amouyel P, Arveiler D, Drygas W, Ferrieres J, Giampaoli S, Kee F, Iacoviello L, Malyutina S, Peters A, Tamosiunas A, Tunstall-Pedoe H, Cesana G. Educational class inequalities in the incidence of coronary heart disease in Europe. Heart 2016; 102:958-65. [PMID: 26849899 DOI: 10.1136/heartjnl-2015-308909] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/11/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations. METHODS The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals. RESULTS N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women. CONCLUSIONS Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.
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Affiliation(s)
- Giovanni Veronesi
- Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Marco M Ferrario
- Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Kari Kuulasmaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Lloyd E Chambless
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Soderberg
- Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark Department of Public Health, Faculty of Medical Science, University of Copenhagen, Copenhagen, Denmark Faculty of Medicine, Aalborg University, Denmark
| | - Philippe Amouyel
- Department of Epidemiology & Public Health, Pasteur Institute of Lille, Lille, France
| | - Dominique Arveiler
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
| | - Wojciech Drygas
- Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Toulouse, France
| | | | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queen's University Belfast, Belfast, UK
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Sofia Malyutina
- The Institute of Internal and Preventive Medicine, Siberian Branch of Russian Academy of Medical Sciences, Novosibirsk, Russian Federation
| | - Annette Peters
- Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Giancarlo Cesana
- Centro Studi e Ricerche in Sanità Pubblica (CESP), Università degli Studi di Milano-Bicocca, Monza, Italy
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The role of health behaviours across the life course in the socioeconomic patterning of all-cause mortality: the west of Scotland twenty-07 prospective cohort study. Ann Behav Med 2014; 47:148-57. [PMID: 24072618 PMCID: PMC3964290 DOI: 10.1007/s12160-013-9539-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Socioeconomic differentials in mortality are increasing in many industrialised countries. Purpose This study aims to examine the role of behaviours (smoking, alcohol, exercise, and diet) in explaining socioeconomic differentials in mortality and whether this varies over the life course, between cohorts and by gender. Methods Analysis of two representative population cohorts of men and women, born in the 1950s and 1930s, were performed. Health behaviours were assessed on five occasions over 20 years. Results Health behaviours explained a substantial part of the socioeconomic differentials in mortality. Cumulative behaviours and those that were more strongly associated with socioeconomic status had the greatest impact. For example, in the 1950s cohort, the age-sex adjusted hazard ratio comparing respondents with manual versus non-manual occupational status was 1.80 (1.25, 2.58); adjustment for cumulative smoking over 20 years attenuated the association by 49 %, diet by 43 %, drinking by 13 % and inactivity by only 1%. Conclusions Health behaviours have an important role in explaining socioeconomic differentials in mortality.
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Stringhini S, Rousson V, Viswanathan B, Gedeon J, Paccaud F, Bovet P. Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region. PLoS One 2014; 9:e102858. [PMID: 25057938 PMCID: PMC4109956 DOI: 10.1371/journal.pone.0102858] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. METHODS All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. RESULTS During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. CONCLUSIONS In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
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Missing heritability or need for reality check of clinical utility in genomic testing? J Hypertens 2014; 32:1395-6. [DOI: 10.1097/hjh.0000000000000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Differential association between adherence to nutritional recommendations and body weight status across educational levels: a cross-sectional study. Prev Med 2013; 57:488-93. [PMID: 23845712 DOI: 10.1016/j.ypmed.2013.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The impact of diet quality and physical activity (PA) on weight might be different according to socioeconomic status. Our aim was to estimate associations between adherence to nutritional guidelines and BMI and the interaction with socioeconomic characteristics. METHODS A total of 11,931 men and 39,737 women from the NutriNet-Santé cohort (France, 2009-2012) were included in this cross-sectional analysis. The association between PNNS-GS (a score estimating adherence to French nutritional guidelines) and BMI was assessed by multivariate linear regression. A modified score (mPNNS-GS) separating diet quality from PA was also used. RESULTS BMI, overweight and obesity displayed an inverse gradient from less to more educated groups, whereas PNNS-GS increased. A higher PNNS-GS was associated with a lower BMI, more importantly in the less educated: BMI decrease ranged from -1.1% in less educated to -0.7% in more educated men and from -0.6% to -0.3% in women. The effect of mPNNS-GS and PA in particular was also stronger among less educated subjects. CONCLUSION Overall, better adherence to nutritional recommendations was inversely associated with BMI, and this association was stronger in the less educated groups. This suggests that nutritional policies should still concentrate on promoting access to a healthier diet and PA, especially among less educated individuals.
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Stringhini S, Spencer B, Marques-Vidal P, Waeber G, Vollenweider P, Paccaud F, Bovet P. Age and gender differences in the social patterning of cardiovascular risk factors in Switzerland: the CoLaus study. PLoS One 2012; 7:e49443. [PMID: 23152909 PMCID: PMC3496703 DOI: 10.1371/journal.pone.0049443] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We examined the social distribution of a comprehensive range of cardiovascular risk factors (CVRF) in a Swiss population and assessed whether socioeconomic differences varied by age and gender. METHODS Participants were 2960 men and 3343 women aged 35-75 years from a population-based survey conducted in Lausanne, Switzerland (CoLaus study). Educational level was the indicator of socioeconomic status used in this study. Analyses were stratified by gender and age group (35-54 years; 55-75 years). RESULTS There were large educational differences in the prevalence of CVRF such as current smoking (Δ = absolute difference in prevalence between highest and lowest educational group:15.1%/12.6% in men/women aged 35-54 years), physical inactivity (Δ = 25.3%/22.7% in men/women aged 35-54 years), overweight and obesity (Δ = 14.6%/14.8% in men/women aged 55-75 years for obesity), hypertension (Δ = 16.7%/11.4% in men/women aged 55-75 years), dyslipidemia (Δ = 2.8%/6.2% in men/women aged 35-54 years for high LDL-cholesterol) and diabetes (Δ = 6.0%/2.6% in men/women aged 55-75 years). Educational inequalities in the distribution of CVRF were larger in women than in men for alcohol consumption, obesity, hypertension and dyslipidemia (p<0.05). Relative educational inequalities in CVRF tended to be greater among the younger (35-54 years) than among the older age group (55-75 years), particularly for behavioral CVRF and abdominal obesity among men and for physiological CVRF among women (p<0.05). CONCLUSION Large absolute differences in the prevalence of CVRF according to education categories were observed in this Swiss population. The socioeconomic gradient in CVRF tended to be larger in women and in younger persons.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
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