Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population
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RESEARCH
(2020) 19:177
Open Access
Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a populationbased cohort study Saman Khalatbari-Soltani1,2* , Fiona Stanaway1, Erin Cvejic1, Fiona M. Blyth1, Vasi Naganathan3,4,5, David J. Handelsman6, David G. Le Couteur4,5,6, Markus J. Seibel6, Louise M. Waite3,4,5 and Robert G. Cumming1,2,4*
Abstract Background: Among 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. Methods: We 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 causespecific 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”. Results: 1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) followup 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. Conclusion: Psychosocial 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. Keywords: Socioeconomic status, Psychosocial factors, Social support, Psychological, distress, Mortality, Older adults
* Correspondence: [email protected]; [email protected] 1 The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or oth
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