Abstract
BackgroundAmong older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality.MethodsWe used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project; baseline recruitment in 2005–2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES; educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using “change-in-estimate method”.Results1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality.ConclusionPsychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.
Highlights
Previous research has demonstrated that socioeconomic inequalities in mortality from all and specific causes persist into older age [1, 2]
We investigated the association of socioeconomic status (SES) with social relationships and psychological distress, as well as the extent to which social relationships and psychological distress are associated with mortality among older adults
The novel aspect in our analysis includes the identification of social relationships with greater precision than before, and the fact that we examined the associations between four individual indicators of SES as well as a cumulative SES score with all-cause mortality and deaths from cardiovascular disease (CVD), cancer, and non-CVD, non-cancer
Summary
Previous research has demonstrated that socioeconomic inequalities in mortality from all and specific causes persist into older age [1, 2]. Individuals with low SES are more likely to have low levels of social support, to be less socially integrated [7, 8], and have higher risk of anxiety and depressive symptoms [9, 10] This has led researchers to hypothesize that social relationships and psychological distress could be one mechanism underlying socioeconomic inequalities in mortality [11]. A small number of studies have investigated the mediating role of social support and psychological distress on SES inequalities in mortality [8, 12,13,14,15,16,17]. The mediating role of social support and psychological distress on SES inequalities in mortality from all and specific causes at older ages, when the burden of mortality is at its greatest, remain unknown. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality
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