Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women

Abstract

SummaryBackgroundIn 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors.MethodsWe did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors.FindingsDuring 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98–1·11) for obesity in men and 2 ·17 (2·06–2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38–1·45 for men; 1·34, 1·28–1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21–1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking.InterpretationSocioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality.FundingEuropean Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. A nationwide population-based study

“…As expected and corroborating results from previous studies, all-cause mortality was much lower in men with high compared to low SES. 14,15 Conclusions Consistent differences according to SES in presentation, waiting times, treatment selection and execution and Pca and allcause mortality were found in men with Pca in Sweden, a country with a tax-financed health care system aiming to provide equal care to all residents. While the reasons for these inequalities in cancer care according to SES remain unknown, these findings underscore the importance of adherence to guidelines to ensure optimal and equal care for all patients diagnosed with cancer.…”

Social stress shortens lifespan in mice

“…Increased life stress and low SES are known risk factors for disease and reduced lifespan in humans (Marmot et al., 1991; Stringhini et al., 2017). Our study demonstrates a conserved role for social stress on shortening lifespan and increasing the risk of cardiovascular disease in a mouse model and identified a potential mechanistic link for this complex phenomenon.…”

“…Notably, a recent multicohort study of 1.7 million adults followed up for mortality (Stringhini et al., 2017) has recognized the effect of SES among other recognized WHO risk factors (i.e., smoking, obesity, diabetes, hypertension, alcohol intake) assigning it a notable 1.26 hazard ratio. Similarly, an association has been demonstrated between psychological stress, senescence as measured by telomere shortening, and increased mortality (Epel & Lithgow, 2014; Epel et al., 2004).…”

Coffee Drinking and Mortality in 10 European Countries

“…1 Indeed, Mendelian randomisation analyses, which are more protected from bias and confounding than the observational findings of Gunter and others, do not support protective effects for high coffee consumption in relation to cardiovascular disease or all-cause mortality. 3 The US NIH, with support from the alcohol industry, is starting a $100 million clinical trial to obtain a definitive answer to the question of whether moderate alcohol consumption prevents heart attacks. As coffee consumption is more widespread and possibly more amenable to change than alcohol consumption, a large-scale trial of coffee consumption is equally justified to obtain definite conclusions about its health effects.…”