title: Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years.
abstract: BACKGROUND
  Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical activity, can account for relative differences in cardiovascular and all-cause mortality by educational level.
  
  
  METHODS
  Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied.
  
  
  RESULTS
  Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small.
  
  
  CONCLUSIONS
  Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.
authors.affiliation: Department of Public Health, University of Helsinki, Finland. mikko.t.laaksonen@helsinki.fi
authors.forename: Mikko
authors.initials: M
authors.lastname: Laaksonen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Talala
authors.forename: Tuija
authors.initials: T
authors.lastname: Martelin
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen
authors.forename: Eva
authors.initials: E
authors.lastname: Roos
authors.forename: Satu
authors.initials: S
authors.lastname: Helakorpi
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
authors.forename: Ritva
authors.initials: R
authors.lastname: Prättälä
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D004032:Diet; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors