Socioeconomic Status Predicts Mortality More Strongly Than...

[Argirios Argiriou]

Socioeconomic Status Predicts Mortality More Strongly Than Some Globally Recognized Risk Factors.

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SUMMARY AND COMMENT | GENERAL MEDICINE

February 14, 2017

Socioeconomic Status Predicts Mortality More Strongly Than Some Globally Recognized Risk Factors
Bruce Soloway, MD Reviewing Tobias M., Lancet 2017 Jan 31;
Should low SES be targeted as a modifiable risk factor?

The World Health Organization has targeted seven modifiable risk factors in its campaign to control noncommunicable diseases: alcohol overuse, physical inactivity, smoking, hypertension, sodium intake, diabetes, and obesity. Low socioeconomic status (SES) strongly predicts morbidity and early mortality worldwide but is not recognized internationally as a modifiable risk factor. To evaluate the contribution of SES to mortality, researchers combined patient-level data from 48 prospective cohort studies, in which 1.7 million people in seven high-income countries provided information on SES (designated as low, intermediate, or high, based on occupation), WHO risk factors, and mortality; participants were followed for a mean 13.3 years.

Overall mortality was higher among people with low SES than among those with high SES (hazard ratios, 1.42 for men and 1.34 for women). The difference remained significant after adjustment for the seven WHO risk factors (HR, 1.26). Differences in mortality from cancer, cardiovascular disease, and other causes were similar. The fraction of excess population mortality attributable to SES was third highest, behind smoking and physical inactivity. Low SES was associated with life expectancy reduction of 2.1 years between ages 40 and 85, which was greater than that for alcohol overuse, obesity, and hypertension.

Comment

The adverse mortality effect of low SES appears to be partially, but not entirely, mediated by other recognized risk factors. The authors and an editorialist argue that SES should be targeted as a modifiable risk factor by applying equitable societal remedies (e.g., access to early childhood education, healthy food, and primary care) alongside individual clinical remedies (e.g. smoking cessation support) that are accessed more often by the relatively privileged.

Editor Disclosures at Time of Publication

Disclosures for Bruce Soloway, MD at time of publication

Nothing to disclose

Citation(s):

Stringhini S et al. 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. Lancet 2017 Jan 31; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
Tobias M.Social rank: A risk factor whose time has come? Lancet 2017 Jan 31; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος