Journal Article

Socioeconomic status, health-related behaviours, and death among older people: the Concord health and aging in men project prospective cohort study

Naganathan, Vasi, Blyth, Fiona M., Handelsman, David J., Le Couteur, David G., Cumming, Robert G., Seibel, Markus J., Khalatbari-Soltani, Saman, Cvejic, Erin, Waite, Louise M.

2020

Overview

Background Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations. Methods We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression. Results We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70); the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality; 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11–25% after adjustment for mediating health-related behaviours. Conclusion Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adults / Age / Aged / Aged, 80 and over / Aging / Alcohol / Analysis / Australia - epidemiology / Australians / Body mass index / Cancer / Cardiovascular diseases / Cohort analysis / Cohort Studies / Educational attainment / Epidemiology / Exercise / Geriatrics / Geriatrics/Gerontology / Health aspects / Health Behavior / Health disparities / Health services / Humans / Investigations / Male / Medicine / Medicine & Public Health / Mens health / Mortality / nutrition and epidemiology / Older people / Physical activity / Physical fitness / Population / Prospective Studies / Public health / Rehabilitation / Research Article / Risk factors / Social Class / Socioeconomic Factors / Socioeconomic issues / Socioeconomic status / Successful aging / Superannuation