Socioeconomic position and mortality risk of smoking: evidence from the English Longitudinal Study of Ageing (ELSA)

Lewer, Dan; McKee, Martin; Gaspirrini, Antonio; Reeves, Aaron; Oliveira, César de

doi:10.1093/eurpub/ckx059

Cited by 20 publications

(16 citation statements)

References 36 publications

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“…Of the five NCD-related modifiable risk factors, physical inactivity and current smoking were most strongly associated with subsequent mortality in both cohorts. This agrees with findings from similar studies in other ageing cohorts in the UK, Brazil and elsewhere 8,11,19,35,36 . Worldwide, physical inactivity and smoking are among the major NCD-related risk factors, considered preventable diseases 1 .…”

Section: Discussionsupporting

confidence: 93%

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Kessler

Thumé

Scholes

et al. 2020

Sci Rep

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To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults. Non-communicable diseases (NCDs) are the main cause of death worldwide, killing 41 million people annually, equivalent to 71% of all deaths globally 1. The main groups of NCDs are cardiovascular diseases (17.9 million deaths), cancers (9.0 million deaths), respiratory diseases (3.9 million deaths), and diabetes (1.6 million deaths) 1. NCDs are often associated with deaths at older age, but evidence shows that a considerable percentage of deaths due to NCDs are premature (before 70 years) 1. The four NCDs listed above cause over 80% of premature deaths, with over 85% occurring in low-and middle-income countries 1. NCD-related health and lifestyle behaviours typically follow the social gradient: people who are disadvantaged in terms of socioeconomic position (SEP) have worse health-and live shorter lives-than those more advantaged 2. Inequalities in social conditions have long-lasting effects during a lifetime that contribute to high levels of NCD-related risk factors 3,4. Socioeconomically disadvantaged persons are at greater risk of being exposed to harmful products, such as tobacco, or of having unhealthy diets, and typically they have lower levels of access to healthcare services 1. Having an unhealthy diet, being physically inactive, and being a cigarette smoker may result in raised blood pressure, increased blood glucose, elevated blood...

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Section: Discussionsupporting

confidence: 93%

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Kessler

Thumé

Scholes

et al. 2020

Sci Rep

Self Cite

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“…This is similar to the results from a Danish study, which found that university graduates and people with ⩾10 years of education presented lower rates of disease compared to those with <10 years of education [51]. In particular, a significant interplay seems to exist between COPD and socioeconomic status [52][53][54][55][56][57]. A significant negative correlation between lung function ( primarily forced expiratory volume in 1 s and forced vital capacity) and socioeconomic status has been established [54].…”

Section: Socioeconomic Status and Copdsupporting

confidence: 86%

“…A relationship exists even after adjusting for smoking status, occupational exposure and race [54]. Smoking is associated with a greater absolute mortality risk due to lung cancer or COPD for individuals in lower socioeconomic groups [55][56][57][58]. Income is inversely associated with COPD treatment initiation [57].…”

Section: Socioeconomic Status and Copdmentioning

confidence: 99%

Impact of the financial crisis on COPD burden: Greece as a case study

et al. 2018

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Poverty and low socioeconomic status have been associated with chronic obstructive pulmonary disease (COPD). The current financial crisis has forced millions back into poverty. Greece is one of the countries hit the hardest, and is in the middle of a deep ongoing collapse. There have been early reports stating the apparent effects of the Greek downturn on respiratory health. This review summarises the overall impact of the financial crisis on COPD burden throughout the period of economic downturn by analysing the case study of Greece. In all levels of the healthcare system, current economic restrictions have reduced the capacity to prevent, diagnose and treat COPD in parallel with current higher detection rates of COPD. Remarkably, expenditure on healthcare has been reduced by >25%, resulting in major healthcare equipment shortages. Lower wages (by up to 20%) and higher co-payments of up to 25% of a drug's purchase price have led to patients struggling to afford inhaled medications. Treatment nonadherence has been reported, resulting in 11.5% more exacerbations and 14.1% more hospitalisations annually, while the mean cost per severe COPD exacerbation has been approximated as €2600. Greece is a noteworthy example illustrating how COPD burden, quality of care and patients' outcome can be affected by economic crisis.

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“…Linking data from death registers with survey and other individual-level data is commonplace in many countries. This practice has enabled a number of prospective cohort studies collecting rich individual-level data, such as the English Longitudinal Study on Ageing (ELSA) and the Health and Retirement Study (HRS), to examine associations between mortality and a wide range of factors (for example see: Lewer et al , 2017 ; Wu et al , 2016 ). The Republic of Ireland has lacked an equivalent data infrastructure and analyses of Irish mortality have therefore been largely limited to unlinked Census data ( Layte & Banks, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Linking death registration and survey data: Procedures and cohort profile for The Irish Longitudinal Study on Ageing

et al. 2020

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Background: Research on mortality at the population level has been severely restricted by an absence of linked death registration and survey data in Ireland. We describe the steps taken to link death registration information with survey data from a nationally representative prospective study of community-dwelling older adults. We also provide a profile of decedents among this cohort and compare mortality rates to population-level mortality data. Finally, we compare the utility of analysing underlying versus contributory causes of death. Methods: Death records were obtained for 779 (90.3% of all confirmed deaths at that time) and linked to individual level survey data from The Irish Longitudinal Study on Ageing (TILDA). Results: Overall, 9.1% of participants died during the nine-year follow-up period and the average age at death was 75.3 years. Neoplasms were identified as the underlying cause of death for 37.0%; 32.9% of deaths were attributable to diseases of the circulatory system; 14.4% due to diseases of the respiratory system; while the remaining 15.8% of deaths occurred due to all other causes. Mortality rates among younger TILDA participants closely aligned with those observed in the population but TILDA mortality rates were slightly lower in the older age groups. Contributory cause of death provides similar estimates as underlying cause when we examined the association between smoking and all-cause and cause-specific mortality. Conclusions: This new data infrastructure provides many opportunities to contribute to our understanding of the social, behavioural, economic, and health antecedents to mortality and to inform public policies aimed at addressing inequalities in mortality and end-of-life care.

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Socioeconomic position and mortality risk of smoking: evidence from the English Longitudinal Study of Ageing (ELSA)

Abstract: Background -It is not clear whether the harm associated with smoking differs by

Cited by 20 publications

References 36 publications

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Impact of the financial crisis on COPD burden: Greece as a case study

Linking death registration and survey data: Procedures and cohort profile for The Irish Longitudinal Study on Ageing

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