Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
PLoS One. 2012;7(7):e39013. doi: 10.1371/journal.pone.0039013. Epub 2012 Jul 25.
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.
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.
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.
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.
在北美和欧洲的国家层面上，都观察到了死亡率方面的社会经济不平等。本研究的目的是利用来自欧洲多个国家的大型队列研究，调查特定风险因素对特定原因死亡率的社会不平等的贡献。
分析了来自 9 个欧洲国家的共 3456689 人/年的欧洲癌症前瞻性调查和营养研究（EPIC）的数据。采用 Cox 比例风险模型，逐步纳入解释变量，研究社会经济地位（SES）与死亡率之间的关联；相对不平等指数（RII）作为相对不平等的衡量指标。
在男性中，最高教育程度的人群的全因死亡率比最低教育程度的人群降低了 43%（HR 0.57，95%CI 0.52-0.61）；在女性中降低了 29%（HR 0.71，95%CI 0.64-0.78）。在男性中，通过引入吸烟因素，风险降低了 7%，在女性中降低了 3%，在引入 BMI 和其他解释变量（饮酒、休闲体力活动、水果和蔬菜摄入）后，风险分别在男性中降低了 2%，在女性中降低了 3%（男性中分别降低了 3%和 5%）。在男性中，所有研究死因的社会不平等均具有统计学意义。在女性中，除癌症相关死亡率和损伤外，所有死因的社会不平等程度较低，但具有统计学意义。
在这项欧洲研究中，报告了欧洲男性和女性中死亡率存在显著的社会经济不平等，这些不平等不能完全通过解释常见的慢性病风险因素来解释。
