Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population-based cohort study

International Journal for Equity in Health

David J. Handelsman¹  Markus J. Seibel¹  David G. Le Couteur²  Vasi Naganathan³  Louise M. Waite³  Fiona Stanaway⁴  Fiona M. Blyth⁴  Erin Cvejic⁴  Saman Khalatbari-Soltani⁵  Robert G. Cumming⁶ 

[1] ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia;Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia;ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia;Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia;The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia;The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia;ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia;The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia;ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia;Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;

关键词: Socioeconomic status;    Psychosocial factors;    Social support;    Psychological, distress;    Mortality;    Older adults;   

DOI  :  10.1186/s12939-020-01277-2

来源: Springer

【 摘 要 】

BackgroundAmong older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality.MethodsWe used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project; baseline recruitment in 2005–2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES; educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using “change-in-estimate method”.Results1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality.ConclusionPsychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.

【 授权许可】

CC BY