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Low socioeconomic status as significant a risk factor for mortality as diabetes, high blood pressure, obesity

To reduce the risk of mortality, local and global health policies should include efforts to address low socioeconomic status as a contributor to poor health, according to findings published in The Lancet.

“Given the huge impact of socioeconomic status on health, it’s vital that governments accept it as a major risk factor and stop excluding in from health policy,” Silvia Stringhini, PhD, from Lausanne University Hospital in Switzerland, said in a press release. “Reducing poverty, improving education and creating safe home, school and work environments are central to overcoming the impact of socioeconomic deprivation. By doing this, socioeconomic status could be targeted and improved, leading to better wealth and health for many.”

Although socioeconomic status correlates to illness and early death globally its’ impact on health status has not been included in WHO’s 25 x 25 initiative, a plan developed to reduce non-communicable diseases by 25% by 2025.

Therefore, researchers performed this multicohort study and meta-analysis to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 x 25 conventional risk factors (physical inactivity, smoking, diabetes, high blood pressure, obesity and high alcohol intake). They used individual data on socioeconomic status, indexed by job title, 25 x 25 risk factors and mortality from 48 independent prospect cohort studies encompassing more than 1.7 million people from seven high-income WHO member countries. They also assessed the population-attributable fraction and the years of life lost due to suboptimal risk factors.

The results revealed that people with low socioeconomic status were almost 1.5 times (46%) more likely to die before the age of 85 years compared with their higher-income counterparts (HR 1.42, 95% CI 1.38 – 1.45 for men; 1.34, 1.28 – 1.39 for women). In mutually adjusted models that included the 25 x 25 factors, this association remained significant (HR 1.26, 1.21 – 1.32 for men and women combined).

Researchers found smoking had the highest population-attributable fraction. This was followed by physical inactivity and then socioeconomic status. They estimated low socioeconomic status was linked to reduced life expectancy of 2.1 years among people aged 40 years to 85 years. Reductions for lives lost were highest for smoking and diabetes (4.8 years and 3.9 years, respectively) compared with lesser years-of-life-lost for high blood pressure, obesity and high alcohol consumption (1.6, 0.7 and 0.5 years, respectively).

“The association between low socioeconomic status and premature mortality was consistent across causes of death, whereas the 25 x 25 risk factors were generally more strongly associated with cardiovascular disease mortality than with cancer and with mortality of other causes,” Stringhini and colleagues wrote in the study.

 “By showing low socioeconomic status has a comparable health effect to that of major risk factors, the results suggest that socioeconomic circumstances, in addition to the 25 x 25 factors, should be treated as a target for local and global health strategies, health risk surveillance, interventions and policy,” they added.– by Savannah Demko

Disclosures: Stringhini reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.