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Title: Social inequalities and mortality in Europe-results from a large multi-national cohort
Authors: 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 O.
Overvad, Kim
Redondo, Maria-Luisa
Agudo, Antonio
Daponte, Antonio
Arriola, Larraitz
Navarro, Carmen
Barricante Gurrea, Aurelio
Khaw, Kay-Tee
Wareham, Nick
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 P
Zackrisson, Sophia
Almquist, Martin
Eriksson, Sture
Hallmans, Göran
Skeie, Guri
Braaten, Tonje
Lund, Eiliv
Illner, Anne-Kathrin
Mouw, Traci
Riboli, Elio
Vineis, Paolo
metadata.dc.contributor.authoraffiliation: [Gallo,V; Ezzati,M; Mouw,T; Riboli,E; Vineis,P] Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. [Gallo,V] Social and Environmental Health Research,London School of Hygiene and Tropical Medicine, London, United Kingdom. [Mackenbach,JP] Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands. [Menvielle,G] Epidemiology of Occupational and Social Determinants of Health, INSERM, Villejuif, France. [Menvielle,G] Universite of Versailles Saint Quentin, Versailles, France. [Kunst,AE] Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. [Rohrmann,S] Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland. [Kaaks,R; Teucher,B] Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany. [Boeing,H; Bergmann,MM] Institute of Human Nutrition, Potsdam-Rehbrücke, Germany. [Tjønneland,A; Dalton,SO] Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. [Overvad,K] Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. [Redondo,M] Public Health and Participation Directorate, Health and Health Care Services Council, Oviedo, Asturias, Spain. [Agudo,A] Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain. [Daponte,A; Arriola,L; Navarro,C; Barricante Gurrea,A] CIBER Epidemiologia y Salud Publica, Barcelona, Spain. [Daponte,A] Andalusian School of Public Health, Granada, Spain. [Arriola,L] Public Health Division of Gipuzkoa, Basque Government, Spain. [Navarro,C] Department of Epidemiology, Regional Health Authority, Murcia, Spain. [Navarro,C] Departamento de Ciencias Sociosanitarias, University of Murcia School of Medicine, Murcia, Spain. [Barricante Gurrea,A] Navarra Public Health Institute, Pamplona, Spain. [Khaw,KT] University of Cambridge, Cambridge, United Kingdom. [Wareham,N] Medical Research Council – Epidemiology Unit, Cambridge, United Kingdom. [Key,T] Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom. [Naska,A; Trichopoulou,A] World Health Organisation Collaborating Centre for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece. [Trichopoulou,A] Hellenic Health Foundation, Athens, Greece. [Trichopoulos,D] Department of Epidemiology, Harvard School of Public Health, Boston, United States of America. [Trichopoulos,D] Bureau of Epidemiologic Research, Academy of Athens, Greece. [Masala,G] Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy. [Panico,S] Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy. [Contiero,T] Cancer Registry and Environmental Epidemiology, Istituto Nazionale Tumori, Milan, Italy. [Tumino,R] Cancer Registry and Histopathological Unit, Civile M. P. Arezzo Hospital, Ragusa, Italy. [Bueno-de-Mesquita,HB] National Institute for Public Health and the Environment, Bilthoven, The Netherlands. [Bueno-de-Mesquita,HB; Siersema,PD] Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands. [Peeters,PP] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. [Zackrisson,S] Department of Clinical Sciences in Malmö , Diagnostic Radiology, Lund University, Sweden. [Almquist,M] Department of Surgery, University Hospital Lund and Lund University, Lund, Sweden. [Eriksson,S; Hallmans,G] Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden. [Skeie,G; Braaten,T; Lund,E] Institutt for samfunnsmedisin, Universitetet i Tromsø, Tromsø, Norway. [Illner,A] Dietary Exposure Assessment Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France.
Keywords: Lung-cancer incidence;Socioeconomic inequalities;Educational inequalities;Cardiovascular risk;Health;Nutrition;Women;Survival;Determinants;Association;Disparidades en atención de salud;Mortalidad;Europa
metadata.dc.subject.mesh: Medical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Delivery of Health Care::Healthcare Disparities
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality
Medical Subject Headings::Geographicals::Geographic Locations::Europe
Issue Date: 25-Jul-2012
Publisher: Public Library of Science
Thomas Behrens, University of Bochum, Germany
Citation: Gallo V, Mackenbach JP, Ezzati M, Menvielle G, Kunst AE, Rohrmann S, et al. Social inequalities and mortality in Europe-results from a large multi-national cohort. PLoS ONE 2012; 7(7):e39013
Abstract: BACKGROUND Socio-economic inequalities in mortality are observed at the country level in both North America and Europe. The purpose of this work is to investigate the contribution of specific risk factors to social inequalities in cause-specific mortality using a large multi-country cohort of Europeans. METHODS A total of 3,456,689 person/years follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) was analysed. Educational level of subjects coming from 9 European countries was recorded as proxy for socio-economic status (SES). Cox proportional hazard model's with a step-wise inclusion of explanatory variables were used to explore the association between SES and mortality; a Relative Index of Inequality (RII) was calculated as measure of relative inequality. RESULTS Total mortality among men with the highest education level is reduced by 43% compared to men with the lowest (HR 0.57, 95% C.I. 0.52-0.61); among women by 29% (HR 0.71, 95% C.I. 0.64-0.78). The risk reduction was attenuated by 7% in men and 3% in women by the introduction of smoking and to a lesser extent (2% in men and 3% in women) by introducing body mass index and additional explanatory variables (alcohol consumption, leisure physical activity, fruit and vegetable intake) (3% in men and 5% in women). Social inequalities were highly statistically significant for all causes of death examined in men. In women, social inequalities were less strong, but statistically significant for all causes of death except for cancer-related mortality and injuries. DISCUSSION In this European study, substantial social inequalities in mortality among European men and women which cannot be fully explained away by accounting for known common risk factors for chronic diseases are reported.
Description: Journal Article; Research Support, Non-U.S. Gov't;
metadata.dc.identifier.doi: 10.1371/journal.pone.0039013
ISSN: 1932-6203 (Online)
Appears in Collections:01- Artículos - EASP. Escuela Andaluza de Salud Pública

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