title: Individual- and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons.
abstract: The authors have studied whether area-level socioeconomic status predicts mortality independently of individual-level socioeconomic status in 179,383 persons in the American Cancer Society Nutrition Cohort, followed for mortality from 1992 to 2000 (17,383 deaths). They used an area-level variable based on census blocks that was an average of home value, income, education, and occupation. Education was the individual-level socioeconomic status variable. The authors studied socioeconomic status-mortality trends with each socioeconomic status variable adjusted for the other. For all causes, an individual's education was strongly and inversely associated with mortality; a weak but significant inverse trend was also present for area-level socioeconomic status. A similar pattern was seen for all-vascular disease. For all cancers, there was again a significant inverse trend with education but no trend with area-level socioeconomic status. Adjustment for conventional (non-socioeconomic status) individual-level risk factors diminished the effect of both socioeconomic status variables, although significant trends remained for men between education and all-cause, all-cancer, and all-vascular disease mortality. Study data indicate that the predictive value of area-level socioeconomic status variables varies by cause of death but is less important than individual-level socioeconomic status variables. Multivariate models that consider socioeconomic status as a potential confounder may not need to consider area-level socioeconomic status if data are available on individual-level education.
authors.affiliation: Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. nsteenl@sph.emlry.edu
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
authors.forename: Jane
authors.initials: J
authors.lastname: Henley
authors.forename: Eugenia
authors.initials: E
authors.lastname: Calle
authors.forename: Michael
authors.initials: M
authors.lastname: Thun
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000401:mortality; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000401:mortality