title: Dynamics of health behaviours and socioeconomic differences in mortality in the USA.
abstract: BACKGROUND
  To measure the explanatory role of behavioural factors to educational and income disparities in mortality among US adults (ages 25+).
  
  
  METHODS
  Data were from four waves of the American Changing Lives Study (N=3617). There were 1832 deaths between 1986 and 2011. Smoking, physical activity, alcohol and body mass index were examined.
  
  
  RESULTS
  Those with 0-11 years of schooling had an 88% (95% CI 48% to 139%) increased risk of dying compared to those with 16+years of schooling. Behavioural factors explained 41% (95% CI 26% to 55%) and 50% (95% CI 30% to 70%) of this excess in models that treated behavioural factors as fixed (single point in time) and time varying (repeated), respectively. The lowest income group (bottom 20th centile) had a 209% (95% CI 172% to 256%) increased risk of dying relative to the highest income group (top 40th centile). Behavioural factors explained 24% (fixed, 95% CI 13% to 35%) and 39% (repeated, 95% CI 22% to 56%) of this difference. Analyses of deaths by causes indicated that behavioural factors were more consequential to disparities in cardiovascular mortality, explaining up to 83% of educational differences, compared to cancer and other death causes.
  
  
  CONCLUSIONS
  Behavioural factors are one of a number of factors which explain socioeconomic mortality disparities, but their estimated explanatory role depends on a number of parameters including the socioeconomic status measure examined, the cause of death and age. In this nationally representative sample, findings based on repeated measures did not warrant a re-evaluation of earlier estimates.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Mehta
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: House
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA Biostatistics Department, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D002423:Cause of Death / Q000639:trends*; D003644:Death Certificates; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D014481:United States / Q000453:epidemiology
keywords: EDUCATION; HEALTH BEHAVIOUR; MORTALITY