title: Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region.
abstract: BACKGROUND
  Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region.
  
  
  METHODS
  All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys.
  
  
  RESULTS
  During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality.
  
  
  CONCLUSIONS
  In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: Silvia
authors: S
authors: Stringhini
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: Valentin
authors: V
authors: Rousson
authors: Ministry of Health, Victoria, Republic of Seychelles.
authors: Bharathi
authors: B
authors: Viswanathan
authors: Ministry of Health, Victoria, Republic of Seychelles.
authors: Jude
authors: J
authors: Gedeon
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: Fred
authors: F
authors: Paccaud
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland; Ministry of Health, Victoria, Republic of Seychelles.
authors: Pascal
authors: P
authors: Bovet
mesh_terms: D000328:Adult; D000368:Aged; D063425:Binge Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000473:pathology; D002423:Cause of Death; D015331:Cohort Studies; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D012750:Seychelles / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D016019:Survival Analysis