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
Dr Silvia Stringhini, PhD*,
Correspondence information about the author Dr Silvia Stringhini
Email the author Dr Silvia Stringhini
, Correspondence information about the author Dr Silvia StringhiniEmail the author Dr Silvia Stringhini
Cristian Carmeli, PhD*
,
Markus Jokela, PhD*
,
Mauricio Avendaño, PhD*
,
Prof Peter Muennig, MD
,
Florence Guida, PhD
,
Fulvio Ricceri, PhD
,
Angelo d'Errico, MD
,
Prof Henrique Barros, PhD
,
Prof Murielle Bochud, PhD
,
Marc Chadeau-Hyam, PhD
,
,
Prof Giuseppe Costa, MD
,
Cyrille Delpierre, PhD
,
Silvia Fraga, PhD
,
Prof Marcel Goldberg, MD
,
Prof Graham G Giles, PhD
,
Vittorio Krogh, MD
,
,
Richard Layte, PhD
,
,
Prof Michael G Marmot, FRCP
,
Prof Martin Preisig, MD
,
Martin J Shipley, MSc
,
Prof Peter Vollenweider, MD
,
Marie Zins, MD
,
Prof Ichiro Kawachi, PhD
,
Prof Andrew Steptoe, Dsc
,
ProfJohan P Mackenbach, PhD
,
Prof Paolo Vineis, PhD†
,
Prof Mika Kivimäki, PhD†
for the
LIFEPATH consortium
*These authors contributed equally to this work
†Joint last authors
‡Members are listed at end of paper
Show all authors
Published: 31 January 2017
Open Access
Open access funded by Medical Research Council
This article can be found in the following collections: Global Health (Ebola Collection); Public Health
Summary
Background
In 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.
Methods
We 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.
Findings
During 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.
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