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

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Author
Gallo, Valentina
Mackenbach, Johan P.
Menvielle, Gwenn
Kunst, Anton E.
Rohrmann, Sabine
Kaaks, Rudolf
Teucher, Birgit
Boeing, Heiner
Bergmann, Manuela M.
Tjønneland, Anne
Dalton, Susanne O.
Overvad, Kim
Redondo, Maria-Luisa
Agudo, Antonio
Daponte, Antonio
Arriola, Larraitz
Navarro, Carmen
Gurrea, Aurelio Barricante
Khaw, Kay-Tee
Wareham, Nick
Key, Tim
Naska, Androniki
Trichopoulou, Antonia
Masala, Giovanna
Panico, Salvatore
Contiero, Paolo
Tumino, Rosario
Bueno-de-Mesquita, H. Bas
Siersema, Peter D.
Peeters, Petra P.
Zackrisson, Sophia
Almquist, Martin
Eriksson, Sture
Hallmans, Göran
Skeie, Guri
Braaten, Tonje
Lund, Eiliv
Illner, Anne-Kathrin
Mouw, Traci
Riboli, Elio
Vineis, Paolo
Note: Order does not necessarily reflect citation order of authors.
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https://doi.org/10.1371/journal.pone.0039013Metadata
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Gallo, Valentina, Johan P. Mackenbach, Majid Ezzati, Gwenn Menvielle, Anton E. Kunst, Sabine Rohrmann, Rudolf Kaaks, et al. 2012. Social inequalities and mortality in Europe – results from a large multi-national cohort. PLoS ONE 7(7): e39013.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.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405077/pdf/Terms of Use
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