Reducing socioeconomic inequalities in all-cause mortality: a counterfactual mediation approach
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Supporting information
Published version
Author(s)
Type
Journal Article
Abstract
Background: Socioeconomicinequalities inmortality arewell 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 underlyingsocioeconomicassociated-mortality and quantifiedthe potentialimpact of reducing early all-cause mortality by hypothetically altering socioeconomic risk factors. Methods: Data were fromsevencohort studies participating in the LIFEPATH consortium (total n=179,090). Using bothsocioeconomic position (SEP) (based on occupation) and education, we estimated thenaturaldirect effect on all-cause mortality, and thenatural indirect effect via the joint mediatingrole of smoking, alcohol intake, dietary patterns, physical activity, body mass index,hypertension, diabetes, and coronary artery disease.Hazard ratios(HR)were estimated, using counterfactual natural effect modelsunder different hypothetical actions of either lower or higher SEP or education. Results: Lower SEP and educationwereassociated with anincreaseinall-cause mortalitywithin an average follow up time of 17.5 years.Mortality wasreducedviamodelled hypothetical actions of increasing SEP oreducation. Through higher educationtheHR was0.85(95% confidence interval (CI) 0.84, 0.86) for women and 0.71(95% CI 0.70, 0.74)for men,compared to lower education. In addition, 34% and 38% of the effect was jointlymediatedfor womenand men, respectively. The benefits from alteringSEP were slightly more modest.Conclusions: Theseobservational findings supportpoliciesto reducemortalityboththrough improving socioeconomic circumstances and increasing education,andby altering intermediaries, such as lifestyle behaviours and morbidities.
Date Issued
2020-04-01
Date Acceptance
2019-10-31
Citation
International Journal of Epidemiology, 2020, 49 (2), pp.497-510
ISSN
0300-5771
Publisher
Oxford University Press (OUP)
Start Page
497
End Page
510
Journal / Book Title
International Journal of Epidemiology
Volume
49
Issue
2
Copyright Statement
This paper is embargoed until publication. Once published it will be available fully open access.
©The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com
Sponsor
Medical Research Council (MRC)
Commission of the European Communities
Grant Number
MR/M501669/1
633666
Subjects
Socio-economic inequalities
all-cause mortality
causal inference
health behaviours
intervention
mediation
multiple mediators
LIFEPATH Consortium
Epidemiology
0104 Statistics
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2019-12-19