부산대학교 도서관

Summary Background In 2011, WHO member states signed up to the 25,x,25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25,x,25 conventional risk factors. Methods We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25,x,25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1,751,479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25,x,25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. Findings During 26*6 million person-years at risk (mean follow-up 13*3 years [SD 6*4 years]), 310,277 participants died. HR for the 25,x,25 risk factors and mortality varied between 1*04 (95% CI 0*98--1*11) for obesity in men and 2,*17 (2*06--2*29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1*42, 95% CI 1*38--1*45 for men; 1*34, 1*28--1*39 for women); this association remained significant in mutually adjusted models that included the 25,x,25 factors (HR 1*26, 1*21--1*32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2*1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0*5 years for high alcohol intake, 0*7 years for obesity, 3*9 years for diabetes, 1*6 years for hypertension, 2*4 years for physical inactivity, and 4*8 years for current smoking. Interpretation Socioeconomic circumstances, in addition to the 25,x,25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. Funding European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology. Author Affiliation: (a) Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland (b) Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland (c) Department of Global Health and Social Medicine, King's College London, London, UK (d) Harvard T H Chan School of Public Health, Boston MA, USA (e) Global Research Analytics for Population Health, Health Policy and Management, Columbia University, New York, NY, USA (f) MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK (g) Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy (h) EPIUnit--Institute of Public Health, University of Porto, Porto, Portugal (i) Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal (j) Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France (k) Department of Biological and Clinical Sciences, Universtiy of Turin, Turin, Italy (l) INSERM, UMR1027, Toulouse, France (m) Universite Toulouse III Paul-Sabatier, UMR1027, Toulouse, France (n) Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France (o) Paris Descartes University, Paris, France (p) Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia (q) Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (r) Department of Sociology, Trinity College Dublin, Dublin, Ireland (s) University College London, Department of Epidemiology and Public Health, London, UK (t) Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands (u) Clinicum, Faculty of Medicine, University of Helsinki, Finland * Correspondence to: Dr Silvia Stringhini, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 10 Route de la Corniche, Lausanne 1010, Switzerland (footnote)* These authors contributed equally to this work (footnote)[Dagger] Joint last authors (footnote)[double dagger] Members are listed at end of paper Byline: Dr Silvia Stringhini, PhD [silvia.stringhini@chuv.ch] (a,*,*), Cristian Carmeli, PhD (a,*), Markus Jokela, PhD (b,*), Mauricio Avendano, PhD (c,d,*), Prof Peter Muennig, MD (e), Florence Guida, PhD (f), Fulvio Ricceri, PhD (g), Angelo d'Errico, MD (g), Prof Henrique Barros, PhD (h,i), Prof Murielle Bochud, PhD (a), Marc Chadeau-Hyam, PhD (f), Francoise Clavel-Chapelon, PhD (j), Prof Giuseppe Costa, MD (k), Cyrille Delpierre, PhD (l,m), Silvia Fraga, PhD (h), Prof Marcel Goldberg, MD (n,o), Prof Graham G Giles, PhD (p), Vittorio Krogh, MD (q), Michelle Kelly-Irving, PhD (l,m), Richard Layte, PhD (r), Aurelie M Lasserre, MD (a), Prof Michael G Marmot, FRCP (s), Prof Martin Preisig, MD (a), Martin J Shipley, MSc (s), Prof Peter Vollenweider, MD (a), Marie Zins, MD (n,o), Prof Ichiro Kawachi, PhD (d), Prof Andrew Steptoe, Dsc (s), Prof Johan P Mackenbach, PhD (t), Prof Paolo Vineis, PhD (f,[Dagger]), Prof Mika Kivimaki, PhD (s,u,[Dagger]), Harri Alenius, Mauricio Avendano, Henrique Barros, Murielle Bochud, Cristian Carmeli, Luca Carra, Raphaele Castagne, Marc Chadeau-Hyam, Francoise Clavel-Chapelon, Giuseppe Costa, Emilie Courtin, Cyrille Delpierre, Angelo D'Errico, Pierre-Antoine Dugue, Paul Elliott, Silvia Fraga, Valerie Gares, Graham Giles, Marcel Goldberg, Dario Greco, Allison Hodge, Michelle Kelly Irving, Piia Karisola, Mika Kivimaki, Vittorio Krogh, Thierry Lang, Richard Layte, Benoit Lepage, Johan Mackenbach, Michael Marmot, Cathal McCrory, Roger Milne, Peter Muennig, Wilma Nusselder, Salvatore Panico, Dusan Petrovic, Silvia Polidoro, Martin Preisig, Olli Raitakari, Ana Isabel Ribeiro, Ana Isabel Ribeiro, Fulvio Ricceri, Oliver Robinson, Jose Rubio Valverde, Carlotta Sacerdote, Roberto Satolli, Gianluca Severi, Martin J Shipley, Silvia Stringhini, Rosario Tumino, Paolo Vineis, Peter Vollenweider, Marie Zins