All-Cause and Cause-specific Death Rates by Educational Status for Two Million People in Two American Cancer Society Cohorts, 1959-1996

医学 社会经济地位 预期寿命 癌症 人口学 队列 乳腺癌 疾病 肺癌 前列腺癌 队列研究 死亡率 死因 老年学 结直肠癌 糖尿病 内科学 人口 环境卫生 内分泌学 社会学
作者
Kyle Steenland
出处
期刊:American Journal of Epidemiology [Oxford University Press]
卷期号:156 (1): 11-21 被引量:223
标识
DOI:10.1093/aje/kwf001
摘要

Low socioeconomic status is associated with high mortality, but the extent to which socioeconomic status affects particular diseases and whether socioeconomic status effects have changed over time are uncertain. The authors used education as a marker for socioeconomic status in a study of two large American Cancer Society cohorts (follow-up, 1959–1996). Low education was associated with higher death rates in both cohorts from all causes and most specific causes, except breast cancer and external causes among women. Life expectancy in the more recent cohort was 4.8 years shorter for men and 2.7 years shorter for women for the least versus the most educated. The inverse relation between education and mortality was strongest for coronary heart disease, lung cancer, diabetes, and chronic obstructive pulmonary disease; moderate for colorectal cancer, external causes (men only), and stroke; weak for prostate cancer; and reversed for external causes among women. The direction of a weak gradient for breast cancer differed for those with and without prevalent breast cancer at baseline. Adjustment for conventional risk factors, probable intermediate variables between education and mortality, diminished but did not eliminate the observed educational/mortality gradients. Temporal trends showed increasing mortality differences by education for coronary heart disease, diabetes, and lung cancer for women.

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