PLoS ONE (Jan 2012)

Social inequalities and mortality in Europe--results from a large multi-national cohort.

  • Valentina Gallo,
  • Johan P Mackenbach,
  • Majid Ezzati,
  • Gwenn Menvielle,
  • Anton E Kunst,
  • Sabine Rohrmann,
  • Rudolf Kaaks,
  • Birgit Teucher,
  • Heiner Boeing,
  • Manuela M Bergmann,
  • Anne Tjønneland,
  • Susanne O Dalton,
  • Kim Overvad,
  • Maria-Luisa Redondo,
  • Antonio Agudo,
  • Antonio Daponte,
  • Larraitz Arriola,
  • Carmen Navarro,
  • Aurelio Barricante Gurrea,
  • Kay-Tee Khaw,
  • Nick Wareham,
  • Tim Key,
  • Androniki Naska,
  • Antonia Trichopoulou,
  • Dimitrios Trichopoulos,
  • Giovanna Masala,
  • Salvatore Panico,
  • Paolo Contiero,
  • Rosario Tumino,
  • H Bas Bueno-de-Mesquita,
  • Peter D Siersema,
  • Petra P Peeters,
  • Sophia Zackrisson,
  • Martin Almquist,
  • Sture Eriksson,
  • Göran Hallmans,
  • Guri Skeie,
  • Tonje Braaten,
  • Eiliv Lund,
  • Anne-Kathrin Illner,
  • Traci Mouw,
  • Elio Riboli,
  • Paolo Vineis

DOI
https://doi.org/10.1371/journal.pone.0039013
Journal volume & issue
Vol. 7, no. 7
p. e39013

Abstract

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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.