Association of Socioeconomic Status with Overall and Cause Specific Mortality in the Republic of Seychelles: Results from a Cohort Study in the African Region
Identifieur interne : 002A63 ( Ncbi/Merge ); précédent : 002A62; suivant : 002A64Association of Socioeconomic Status with Overall and Cause Specific Mortality in the Republic of Seychelles: Results from a Cohort Study in the African Region
Auteurs : Silvia Stringhini [Suisse] ; Valentin Rousson [Suisse] ; Bharathi Viswanathan ; Jude Gedeon ; Fred Paccaud [Suisse] ; Pascal Bovet [Suisse]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region.
All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys.
During a mean follow-up of 15.0 years (range 0–23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24–2.62), CVD (HR = 1.95; 1.04–3.65) and non-cancer/non-CVD (HR = 2.14; 1.10–4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76–2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality.
In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
Url:
DOI: 10.1371/journal.pone.0102858
PubMed: 25057938
PubMed Central: 4109956
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Rousson</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Viswanathan, Bharathi" sort="Viswanathan, Bharathi" uniqKey="Viswanathan B" first="Bharathi" last="Viswanathan">Bharathi Viswanathan</name><affiliation><nlm:aff id="aff2"><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></nlm:aff><wicri:noCountry code="subfield">Republic of Seychelles</wicri:noCountry></affiliation></author><author><name sortKey="Gedeon, Jude" sort="Gedeon, Jude" uniqKey="Gedeon J" first="Jude" last="Gedeon">Jude Gedeon</name><affiliation><nlm:aff id="aff2"><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></nlm:aff><wicri:noCountry code="subfield">Republic of Seychelles</wicri:noCountry></affiliation></author><author><name sortKey="Paccaud, Fred" sort="Paccaud, Fred" uniqKey="Paccaud F" first="Fred" last="Paccaud">Fred Paccaud</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Bovet, Pascal" sort="Bovet, Pascal" uniqKey="Bovet P" first="Pascal" last="Bovet">Pascal Bovet</name><affiliation wicri:level="3"><nlm:aff 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Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Rousson, Valentin" sort="Rousson, Valentin" uniqKey="Rousson V" first="Valentin" last="Rousson">Valentin Rousson</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Viswanathan, Bharathi" sort="Viswanathan, Bharathi" uniqKey="Viswanathan B" first="Bharathi" last="Viswanathan">Bharathi Viswanathan</name><affiliation><nlm:aff id="aff2"><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></nlm:aff><wicri:noCountry code="subfield">Republic of Seychelles</wicri:noCountry></affiliation></author><author><name sortKey="Gedeon, Jude" sort="Gedeon, Jude" uniqKey="Gedeon J" first="Jude" last="Gedeon">Jude Gedeon</name><affiliation><nlm:aff id="aff2"><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></nlm:aff><wicri:noCountry code="subfield">Republic of Seychelles</wicri:noCountry></affiliation></author><author><name sortKey="Paccaud, Fred" sort="Paccaud, Fred" uniqKey="Paccaud F" first="Fred" last="Paccaud">Fred Paccaud</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Bovet, Pascal" sort="Bovet, Pascal" uniqKey="Bovet P" first="Pascal" last="Bovet">Pascal Bovet</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation><affiliation><nlm:aff id="aff2"><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></nlm:aff><wicri:noCountry code="subfield">Republic of Seychelles</wicri:noCountry></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region.</p></sec><sec><title>Methods</title><p>All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys.</p></sec><sec><title>Results</title><p>During a mean follow-up of 15.0 years (range 0–23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24–2.62), CVD (HR = 1.95; 1.04–3.65) and non-cancer/non-CVD (HR = 2.14; 1.10–4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76–2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality.</p></sec><sec><title>Conclusions</title><p>In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Stringhini, S" uniqKey="Stringhini S">S Stringhini</name></author><author><name sortKey="Dugravot, A" uniqKey="Dugravot A">A Dugravot</name></author><author><name sortKey="Shipley, M" uniqKey="Shipley M">M Shipley</name></author><author><name sortKey="Goldberg, M" uniqKey="Goldberg M">M Goldberg</name></author><author><name sortKey="Zins, M" uniqKey="Zins M">M Zins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mackenbach, Jp" uniqKey="Mackenbach J">JP Mackenbach</name></author><author><name sortKey="Bos, V" uniqKey="Bos V">V Bos</name></author><author><name sortKey="Andersen, O" uniqKey="Andersen O">O Andersen</name></author><author><name sortKey="Cardano, M" uniqKey="Cardano M">M 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25057938</article-id><article-id pub-id-type="pmc">4109956</article-id><article-id pub-id-type="publisher-id">PONE-D-14-01974</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0102858</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Social Epidemiology</subject></subj-group></subj-group><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Global Health</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Association of Socioeconomic Status with Overall and Cause Specific Mortality in the Republic of Seychelles: Results from a Cohort Study in the African Region</article-title><alt-title alt-title-type="running-head">Socioeconomic Status and Mortality in the Seychelles</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Stringhini</surname><given-names>Silvia</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rousson</surname><given-names>Valentin</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Viswanathan</surname><given-names>Bharathi</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gedeon</surname><given-names>Jude</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Paccaud</surname><given-names>Fred</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bovet</surname><given-names>Pascal</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Ministry of Health, Victoria, Republic of Seychelles</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>da Silva Nunes</surname><given-names>Monica</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Universidade Federal do Acre (Federal University of Acre), Brazil</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>silvia.stringhini@chuv.ch</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: SS PB. Performed the experiments: SS VR PB. Analyzed the data: SS VR. Contributed reagents/materials/analysis tools: BV JG PB. Wrote the paper: SS VR BV JG FP PB. Data collection: BV PB.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>24</day><month>7</month><year>2014</year></pub-date><volume>9</volume><issue>7</issue><elocation-id>e102858</elocation-id><history><date date-type="received"><day>16</day><month>1</month><year>2014</year></date><date date-type="accepted"><day>24</day><month>6</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Stringhini et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region.</p></sec><sec><title>Methods</title><p>All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys.</p></sec><sec><title>Results</title><p>During a mean follow-up of 15.0 years (range 0–23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24–2.62), CVD (HR = 1.95; 1.04–3.65) and non-cancer/non-CVD (HR = 2.14; 1.10–4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76–2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality.</p></sec><sec><title>Conclusions</title><p>In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.</p></sec></abstract><funding-group><funding-statement>SS is supported by an Ambizione Grant (n ° PZ00P3_147998) from the Swiss National Science Foundation (SNSF) and was supported by a fellowship awarded by the Swiss School of Public Health (SSPH+) during the preparation of this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="8"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Suisse</li></country><region><li>Canton de Vaud</li></region><settlement><li>Lausanne</li></settlement></list><tree><noCountry><name sortKey="Gedeon, Jude" sort="Gedeon, Jude" uniqKey="Gedeon J" first="Jude" last="Gedeon">Jude Gedeon</name><name sortKey="Viswanathan, Bharathi" sort="Viswanathan, Bharathi" uniqKey="Viswanathan B" first="Bharathi" last="Viswanathan">Bharathi Viswanathan</name></noCountry><country name="Suisse"><region name="Canton de Vaud"><name sortKey="Stringhini, Silvia" sort="Stringhini, Silvia" uniqKey="Stringhini S" first="Silvia" last="Stringhini">Silvia Stringhini</name></region><name sortKey="Bovet, Pascal" sort="Bovet, Pascal" uniqKey="Bovet P" first="Pascal" last="Bovet">Pascal Bovet</name><name sortKey="Paccaud, Fred" sort="Paccaud, Fred" uniqKey="Paccaud F" first="Fred" last="Paccaud">Fred Paccaud</name><name sortKey="Rousson, Valentin" sort="Rousson, Valentin" uniqKey="Rousson V" first="Valentin" last="Rousson">Valentin Rousson</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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