@article{3156036,
    title = "Social Inequalities and Mortality in Europe - Results from a Large
Multi-National Cohort",
    author = "Gallo, Valentina and Mackenbach, Johan P. and Ezzati, Majid and and Menvielle, Gwenn and Kunst, Anton E. and Rohrmann, Sabine and Kaaks, and Rudolf and Teucher, Birgit and Boeing, Heiner and Bergmann, Manuela M. and and Tjonneland, Anne and Dalton, Susanne O. and Overvad, Kim and and Redondo, Maria-Luisa and Agudo, Antonio and Daponte, Antonio and and Arriola, Larraitz and Navarro, Carmen and Barricante Gurrea, Aurelio and and Khaw, Kay-Tee and Wareham, Nick and Key, Tim and Naska, Androniki and and Trichopoulou, Antonia and Trichopoulos, Dimitrios and Masala, Giovanna and and Panico, Salvatore and Contiero, Paolo and Tumino, Rosario and and Bueno-de-Mesquita, H. Bas and Siersema, Peter D. and Peeters, Petra P. and and Zackrisson, Sophia and Almquist, Martin and Eriksson, Sture and and Hallmans, Goran and Skeie, Guri and Braaten, Tonje and Lund, Eiliv and and Illner, Anne-Kathrin and Mouw, Traci and Riboli, Elio and Vineis, Paolo",
    journal = "PLOS ONE",
    year = "2012",
    volume = "7",
    number = "7",
    publisher = "Public Library of Science",
    doi = "10.1371/journal.pone.0039013",
    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 socioeconomic 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."
}