| Title: | Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study |
| Journal: | Lancet Public Health |
| Published: | 1 Sep 2023 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/37633676/ |
| DOI: | https://doi.org/10.1016/S2468-2667(23)00153-6 |
| URL: | https://www.sciencedirect.com/science/article/pii/S2468266723001536 |
Publication 20
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Abstract
BackgroundSocial inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City.
Methods The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors.
Findings Among 143478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1.84; 95% CI 1.71-1.98), equivalent to approximately 6 years lower life expectancy, with an RR of 1.78 (1.67-1.90) among participants with incomplete primary, 1.62 (1.53-1.72) with complete primary, and 1.34 (1.25-1.42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3.65; 95% CI 3.05-4.38 for no education vs tertiary education) and from infectious diseases (2.67; 2.00-3.56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality.
Interpretation In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality.
20 Authors
- Thomas Addey
- Jesus Alegre-Díaz
- Fiona Bragg
- Eirini Trichia
- Rachel Wade
- Rogelio Santacruz-Benitez
- Raúl Ramirez-Reyes
- Adrián Garcilazo-Ávila
- Carlos Gonzáles-Carballo
- Omar Yaxmehen Bello-Chavolla
- Neftali Eduardo Antonio-Villa
- Diego Aguilar-Ramirez
- Louisa Gnatiuc Friedrichs
- Sarah Lewington
- Richard Peto
- Rory Collins
- Jaime Berumen
- Jonathan R Emberson
- Pablo Kuri-Morales
- Roberto Tapia-Conyer