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Cited by 237Health disparities and outcomesPublic Health and Social InequalitiesGlobal Cancer Incidence and Screening

Association among socioeconomic status, health behaviors, and all-cause mortality in the United States

Nandi, Arijit, Glymour, M. Maria, Subramanian, S. V.·2014·Epidemiology
DOI 10.1097/ede.0000000000000038
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Abstract

BACKGROUND: Health behaviors may contribute to socioeconomic inequalities in mortality, although the extent of such contribution remains unclear. We assessed the extent to which smoking, alcohol consumption, and physical inactivity have mediated the association between socioeconomic status (SES) and all-cause mortality in a representative sample of US adults. METHODS: Initiated in 1992, the Health and Retirement Study is a longitudinal, biennial survey of a national sample of US adults born between 1931 and 1941. Our analyses are based on a sample of 8037 participants enrolled in 1992 and followed for all-cause mortality from 1998 through 2008. We used exploratory and confirmatory factor analysis to derive a measure of adult SES based on respondents' education, occupation, labor force status, household income, and household wealth. Potential mediators (smoking, alcohol consumption, and physical inactivity) were assessed biennially. We used inverse probability-weighted mediation models to account for time-varying covariates. RESULTS: During the 10-year mortality follow-up, 859 (10%) participants died. After accounting for age, sex, and baseline confounders, being in the most-disadvantaged quartile of SES compared with the least disadvantaged was associated with a mortality risk ratio of 2.84 (95% confidence interval = 2.25-3.60). Together, smoking, alcohol consumption, and physical inactivity explained 68% (35-104%) of this association, leaving a risk ratio of 1.59 (1.03-2.45) for low SES. CONCLUSIONS: The distribution of health-damaging behaviors may explain a substantial proportion of excess mortality associated with low SES in the United States, suggesting the importance of social inequalities in unhealthy behaviors.

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  • Lower SES during both childhood and adulthood predicts increased mortality.

    “Results from the nationally representative Health and Retirement Study (HRS) show that lower SES during both childhood and adulthood predict worse self-rated health, greater chronic conditions in later life (Luo and Waite, 2005), and increased mortality (Galobardes et al., 2004; Nandi et al., 2014).”

    From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Nandi et al., 2014

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Authors
Nandi, A., Glymour, M. M., & Subramanian, S. V.
Affiliations
Harvard University (US)
Corresponding author
Nandi, Arijit
ORCID
Venue
Epidemiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-03
Volume
25
Issue
2
Pages
170-177
ISSN
1044-3983 (ISSN-L)
DOI
10.1097/ede.0000000000000038
OpenAlex
W1990749085
Cited by
237
References
30
Citations by year
2026: 9 · 2025: 14 · 2024: 17 · 2023: 17 · 2022: 19 · 2021: 22 · 2020: 17 · 2019: 23 · 2018: 27 · 2017: 27 · 2016: 16 · 2015: 24 · 2014: 5
FWCI
30.55
Type
journal article
Language
en
Open access
closed
Locations
  • Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
socioeconomic status, all-cause mortality, health behavior, smoking, alcohol consumption, physical inactivity, mediation analysis, socioeconomic inequalities in mortality, Health and Retirement Study, middle-aged and older adults
MeSH terms
Adult, Aged, Aged, 80 and over, Alcohol Drinking, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Smoking, Social Class, United States, Health Behavior, Linear Models, Odds Ratio, Health Status Disparities, Sedentary Behavior

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