The Role of Health Behaviours Across the Life Course in the Socioeconomic Patterning of All-Cause Mortality: The West of
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ORIGINAL ARTICLE
The Role of Health Behaviours Across the Life Course in the Socioeconomic Patterning of All-Cause Mortality: The West of Scotland Twenty-07 Prospective Cohort Study Elise Whitley, B.Sc., M.Sc., Ph.D. & G. David Batty, Ph.D. Kate Hunt, B.Sc., M.Sc., Ph.D. & Frank Popham, B.A., Ph.D. & Michaela Benzeval, B.Sc., M.Sc., P.G.C.A.P., Ph.D.
# The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Background Socioeconomic differentials in mortality are increasing in many industrialised countries. Purpose This study aims to examine the role of behaviours (smoking, alcohol, exercise, and diet) in explaining socioeconomic differentials in mortality and whether this varies over the life course, between cohorts and by gender. Methods Analysis of two representative population cohorts of men and women, born in the 1950s and 1930s, were performed. Health behaviours were assessed on five occasions over 20 years. Results Health behaviours explained a substantial part of the socioeconomic differentials in mortality. Cumulative behaviours and those that were more strongly associated with socioeconomic status had the greatest impact. For example, in the 1950s cohort, the age-sex adjusted hazard ratio comparing respondents with manual versus non-manual occupational status was 1.80 (1.25, 2.58); adjustment for cumulative smoking over 20 years attenuated the association by 49 %, diet by 43 %, drinking by 13 % and inactivity by only 1%. Conclusions Health behaviours have an important role in explaining socioeconomic differentials in mortality.
E. Whitley (*) : K. Hunt : F. Popham : M. Benzeval MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK e-mail: [email protected] G. D. Batty Department of Epidemiology and Public Health, University College London, London, UK G. D. Batty Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
Keywords Mortality . Socioeconomic status . Health behaviours . Cohort
Introduction Socioeconomic differentials in mortality are well established, with the highest mortality rates observed in lower socioeconomic groups [1–3]. Differentials have been identified in many populations and are increasing in many industrialised countries despite falling mortality rates overall [4, 5]. Explanations for these inequalities include different patterns of material, cognitive, biomedical, psychosocial and behavioural risk factors in different socioeconomic groups, but the extent to which these factors explain socioeconomic differences in mortality remains unclear. Behavioural risk factors are most amenable to change and are of particular interest in terms of reducing inequalities. Previous studies have explored the role of health behaviours in explaining mortality associations with occupational socioeconomic status (SES) [6–11], education [7, 10–19] and income [7, 12, 17–21], and generally indicate that health behaviours have an impact, although the relative impor
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