title: Social inequalities and mortality in Europe--results from a large multi-national cohort.
abstract: BACKGROUND
  Socio-economic inequalities in mortality are observed at the country level in both North America and Europe. The purpose of this work is to investigate the contribution of specific risk factors to social inequalities in cause-specific mortality using a large multi-country cohort of Europeans.
  
  
  METHODS
  A total of 3,456,689 person/years follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) was analysed. Educational level of subjects coming from 9 European countries was recorded as proxy for socio-economic status (SES). Cox proportional hazard model's with a step-wise inclusion of explanatory variables were used to explore the association between SES and mortality; a Relative Index of Inequality (RII) was calculated as measure of relative inequality.
  
  
  RESULTS
  Total mortality among men with the highest education level is reduced by 43% compared to men with the lowest (HR 0.57, 95% C.I. 0.52-0.61); among women by 29% (HR 0.71, 95% C.I. 0.64-0.78). The risk reduction was attenuated by 7% in men and 3% in women by the introduction of smoking and to a lesser extent (2% in men and 3% in women) by introducing body mass index and additional explanatory variables (alcohol consumption, leisure physical activity, fruit and vegetable intake) (3% in men and 5% in women). Social inequalities were highly statistically significant for all causes of death examined in men. In women, social inequalities were less strong, but statistically significant for all causes of death except for cancer-related mortality and injuries.
  
  
  CONCLUSIONS
  In this European study, substantial social inequalities in mortality among European men and women which cannot be fully explained away by accounting for known common risk factors for chronic diseases are reported.
authors: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors: Valentina
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authors: Gallo
authors: Johan P
authors: JP
authors: Mackenbach
authors: Majid
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authors: Ezzati
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authors: Menvielle
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authors: Kunst
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authors: Rohrmann
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authors: Teucher
authors: Heiner
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authors: Boeing
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authors: MM
authors: Bergmann
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authors: Tjønneland
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authors: Dalton
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authors: Overvad
authors: Maria-Luisa
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authors: Redondo
authors: Antonio
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authors: Agudo
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authors: Daponte
authors: Larraitz
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authors: Arriola
authors: Carmen
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authors: Navarro
authors: Aurelio Barricante
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authors: Gurrea
authors: Kay-Tee
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authors: Nick
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authors: Wareham
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authors: Key
authors: Androniki
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authors: Naska
authors: Antonia
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authors: Trichopoulou
authors: Dimitrios
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authors: Trichopoulos
authors: Giovanna
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authors: Masala
authors: Salvatore
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authors: Panico
authors: Paolo
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authors: Contiero
authors: Rosario
authors: R
authors: Tumino
authors: H Bas
authors: HB
authors: Bueno-de-Mesquita
authors: Peter D
authors: PD
authors: Siersema
authors: Petra P
authors: PP
authors: Peeters
authors: Sophia
authors: S
authors: Zackrisson
authors: Martin
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authors: Almquist
authors: Sture
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authors: Eriksson
authors: Göran
authors: G
authors: Hallmans
authors: Guri
authors: G
authors: Skeie
authors: Tonje
authors: T
authors: Braaten
authors: Eiliv
authors: E
authors: Lund
authors: Anne-Kathrin
authors: AK
authors: Illner
authors: Traci
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authors: Mouw
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authors: Riboli
authors: Paolo
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authors: Vineis
mesh_terms: D000328:Adult; D005062:European Union; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors