Social Inequalities and Mortality in Europe – Results from a Large Multi-National Cohort

Gallo, Valentina; Mackenbach, Johan P.; Ezzati, Majid; Menvielle, Gwenn; Kunst, Anton E.; Rohrmann, Sabine; Kaaks, Rudolf; Teucher, Birgit; Boeing, Heiner; Bergmann, Manuela M.; Tjønneland, Anne; Dalton, Susanne Oksbjerg; Overvad, Kim; Redondo, María-Luisa; Agudo, Antonio; Daponte, Antonio; Arriola, Larraitz; Navarro, Carmen; Gurrea, Aurelio Barricante; Khaw, Kay‐Tee; Wareham, Nicholas J.; Key, Tim; Naska, Androniki; Trichopoulou, Antonia; Trichopoulos, Dimitrios; Masala, Giovanna; Panico, Salvatore; Contiero, Paolo; Tumino, Rosario; Bueno-de-Mesquita, H. Bas; Siersema, Peter D.; Peeters, Petra; Zackrisson, Sophia; Almquist, Martin; Eriksson, Sture; Hallmans, Göran; Skeie, Guri; Br̈aaten, Tonje; Lund, Eiliv; Illner, Anne‐Kathrin; Mouw, Traci; Riboli, Elio; Víneis, Paolo

doi:10.1371/journal.pone.0039013

Cited by 120 publications

(111 citation statements)

References 36 publications

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“…This finding is consistent with most existing studies [16] [17]. People with a lower education level experience a higher burden of cancer [17].…”

Section: Discussionsupporting

confidence: 92%

Bone Cancer Mortality in Inner Mongolia from 2008 to 2012

Guo¹,

Hao²,

Du³

et al. 2015

OJEpi

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Objective: The aim of our study was to assess bone cancer mortality and the related social factors in Inner Mongolia in China. Methods: We obtained data from the Centers for Disease Control in Inner Mongolia from five monitoring points of the Death Registry System in Inner Mongolia from 2008 to 2012. We calculated the crude mortality rate for bone cancer. The χ 2 test was used to examine differences in bone cancer mortality rates between sexes and years. Unconditional logistic regressions were applied to analyze the effect of socio-demographic characteristics by sex. Results: Between 2008 and 2012, the crude mortality rate of bone cancer was 1.12/100000 (95% confidence interval = 1.02 -1.21). The bone cancer mortality was 2.24 in men and 1.25 in women, resulting in a male-female ratio of 1.8. No between-year difference in the mortality rate was observed between 2008 and 2012 (men: χ 2 = 4.65, P = 0.325; women: χ 2 = 2.21, P = 0.698). In general, mortality increased with increasing age. People with a lower education level exhibited an increased risk of bone cancer among both men and women. Jobs involving extensive manual labor decreased the likelihood of bone cancer mortality, and the odds ratio was higher for men than women (0.6 vs. 0.45). Unmarried people had a higher risk for bone cancer than married people. Conclusion: The mortality rate of bone cancer was not significantly different between men and women from 2008 to 2012. The risk of bone cancer increased with age among both sexes. Unmarried people and those with a low education status had an elevated risk of bone cancer, whereas employment in a field involving extensive manual labor appeared to be a protective factor against bone cancer.

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“…This finding is consistent with most existing studies [16] [17]. People with a lower education level experience a higher burden of cancer [17].…”

Section: Discussionsupporting

confidence: 92%

Bone Cancer Mortality in Inner Mongolia from 2008 to 2012

Guo¹,

Hao²,

Du³

et al. 2015

OJEpi

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“…Time trend studies have shown that absolute inequalities in cerebrovascular disease mortality are declining in many European countries, and reported larger reductions in death rates among the less educated individuals 20. Gallo and colleagues21 estimated that the least educated European men and women had a 42% and 41% overall excess risk of age-adjusted stroke death, respectively. In our analysis of middle-aged European adults initially free of cardiovascular disease, inequalities between the least and most educated were more commonly observed for stroke incidence than for stroke death rates, being statistically significant in 8 out of the 13 investigated populations in men and in 5 out of 11 in women.…”

Section: Discussionmentioning

confidence: 99%

“…First, in most regions and gender groups, the major contributors to educational inequalities in stroke incidence were behavioural risk factors, that is, cigarette smoking, alcohol intake and BMI. From the paper by Gallo et al ,21 it is possible to infer that the same behavioural risk factors, in addition to the levels of physical activity and vegetable and fruit consumption, explain up to 39.7% and 18.4% of the risk in men and women, respectively. The presence of a synergistic effect of smoking with low education on the risk of stroke8 and cardiovascular diseases23 would suggest that targeting the most disadvantaged individuals might be worthwhile in order to reduce both inequalities and disease rates at a population level.…”

Section: Discussionmentioning

confidence: 99%

Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies

Veronesi

Kee

Chambless

et al. 2017

J Epidemiol Community Health

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BackgroundKnowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.Materials and methodsThe MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.ResultsCompared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86–413 and 78–156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%–130% and 40%–89% of the average incidence rates. Inequalities in risk factors accounted for 45%–70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.ConclusionsSocial inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

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“…Socioeconomic inequalities in mortality and selfreported morbidity have been extensively documented in national and international studies [1][2][3][4][5][6][7]. For both of these outcomes, and either defined by educational or income level, rates are higher in the lower socioeconomic groups.…”

Section: Introductionmentioning

confidence: 99%

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

Hoffmann

Gelder

et al. 2016

European Journal of Public Health

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Background: The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010.Methods: Nationally representative survey data from 15 European countries were harmonized and used in a metaregression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. Results: A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. Conclusion:The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

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Social Inequalities and Mortality in Europe – Results from a Large Multi-National Cohort

Cited by 120 publications

References 36 publications

Bone Cancer Mortality in Inner Mongolia from 2008 to 2012

Bone Cancer Mortality in Inner Mongolia from 2008 to 2012

Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

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