Abstract
BackgroundConflicting 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.MethodsWe 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.ResultsWe 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.ConclusionLow 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.
Highlights
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
A priori, we examined whether the associations between individual SES measures and cumulative SES scores and mortality varied by age, testing for statistical interaction by age and conducting analysis stratified by age (70–79 and 80+)
We found no association between housing tenure and all-cause or cause-specific mortality, which differs from previous findings in the literature
Summary
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. Most studies of socioeconomic inequalities in mortality have relied on a single indicator of SES, mainly education, and have examined only all-cause mortality or one cause of death at a time [5] Behavioural risk factors, such as heavy drinking, smoking, physical inactivity, and unhealthy diet, have been proposed as one of the underlying pathways explaining the SES gradient in mortality [11]. Among older individuals, little evidence, with mixed results, exists regarding the mediating impact of health-related behaviours on SES inequalities in mortality [15,16,17,18] The inconsistency among these studies may be explained by the different SES indicators used, as well as differences in participant characteristics and whether health-related behaviours were assessed using single or longitudinal measures. Previous studies have shown that the mediating impact of health-related behaviours differed by age [15], study design [3], and location [19]
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