The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia.
BMC Geriatr. 2020 Jul 29;20(1):261. doi: 10.1186/s12877-020-01648-y.
Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations.
We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression.
We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70); the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality; 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11-25% after adjustment for mediating health-related behaviours.
Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.
关于社会经济地位（SES）与老年人死亡率之间的关联存在相互矛盾的证据，并且对于这种关联的潜在机制知之甚少。我们调查了 SES 与澳大利亚老年男性死亡率之间的关联。我们还调查了健康相关行为在 SES 与死亡率关联中的潜在中介作用。
我们使用了来自澳大利亚悉尼一项前瞻性人群队列研究（Concord 健康与老龄化男性项目）的数据。主要结局是全因死亡率和死因特异性死亡率。在基线时评估了教育程度、职业地位、收入来源、住房所有权和累积 SES 评分。纵向评估了饮酒、吸烟、身体活动和体重指数，以探讨其作为潜在的中介因素。使用 Cox 回归来量化关联。
我们评估了 1527 名男性（平均年龄：77.4±5.5 岁）。在平均 9.0 年的随访期间，发生了 783 例死亡。对于所有原因导致的死亡，累积 SES 评分最低三分位与最高三分位相比，调整后的危险比（HR）为 1.44（95%CI 1.21 至 1.70）；心血管疾病（CVD）死亡率的相应亚 HR 为 1.35（0.96 至 1.89）；癌症死亡率为 1.58（1.15 至 2.18）；非 CVD、非癌症死亡率为 1.86（1.36 至 2.56）。调整健康相关行为的中介作用后，SES 与死亡率的关联减弱了 11-25%。
低 SES 与澳大利亚老年男性死亡率升高相关，健康相关行为仅占这些关联的四分之一以下。需要进一步研究以充分了解 SES 与老年人死亡率之间不平等的潜在机制。
