Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

Détails

Ressource 1Télécharger: 31855265_BIB_67F9FC00C0AA.pdf (420.50 [Ko])
Etat: Public
Version: Final published version
Licence: CC BY-NC 4.0
ID Serval
serval:BIB_67F9FC00C0AA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.
Périodique
International journal of epidemiology
Auteur⸱e⸱s
Laine J.E., Baltar V.T., Stringhini S., Gandini M., Chadeau-Hyam M., Kivimaki M., Severi G., Perduca V., Hodge A.M., Dugué P.A., Giles G.G., Milne R.L., Barros H., Sacerdote C., Krogh V., Panico S., Tumino R., Goldberg M., Zins M., Delpierre C., Vineis P.
Collaborateur⸱rice⸱s
LIFEPATH Consortium
Contributeur⸱rice⸱s
Alenius H., Avendano M., Baltar V., Bartley M., Barros H., Bochud M., Carmeli C., Carra L., Castagné R., Chadeau-Hyam M., Clavel-Chapelon F.O., Costa G., Courtin E., Delpierre C., Donkin A., D'Errico A., Dugué P.A., Elliott P., Fiorito G., Fraga S., Garès V., Gandini M., Giles G., Goldberg M., Greco D., Hodge A., Karimi M., Kelly-Irving M., Karisola P., Kivimaki M., Krogh V., Laine J., Lang T., Layte R., Lepage B., Mackenbach J., Marmot M., de Mestral C., McCrory C., Milne R., Muennig P., Nusselder W., Panico S., Petrovic D., Polidoro S., Preisig M., Raitakari O., Ribeiro A.I., Ricceri F., Reinhard E., Robinson O., Valverde J.R., Sacerdote C., Satolli R., Severi G., Shipley M.J., Stringhini S., Tumino R., Tieulent J., Vaccarella S., Vergnaud A.C., Vineis P., Vollenweider P., Zins M.
ISSN
1464-3685 (Electronic)
ISSN-L
0300-5771
Statut éditorial
Publié
Date de publication
01/04/2020
Peer-reviewed
Oui
Volume
49
Numéro
2
Pages
497-510
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors.
Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education.
Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5 years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest.
These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.
Mots-clé
Socio-economic inequalities, all-cause mortality, causal inference, health behaviours, intervention, mediation, multiple mediators
Pubmed
Web of science
Open Access
Oui
Création de la notice
03/01/2020 16:38
Dernière modification de la notice
15/01/2021 7:09
Données d'usage