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