title: Psycho-socioeconomic bio-behavioral associations on all-cause mortality: cohort study.
abstract: BACKGROUND
  The purpose of this study was to examine the cumulative effects of psychological,socioeconomic, biological and behavioral parameters on mortality.
  
  
  METHODS
  A prospective design was employed. Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used (analyzed in 2015); follow-up mortality status evaluated in 2011. Psychological function was assessed from the Patient Health Questionnaire-9 (PHQ-9) as a measure of depression. Socioeconomic risk was assessed from poverty level, education, minority status, and social living status. Biological parameters included cholesterol, weight status, diabetes, hypertension and systemic inflammation. Behavioral parameters assessed included physical activity (accelerometry), dietary behavior, smoking status (cotinine) and sleep. These 14 psycho-socioeconomic bio-behavioral (PSBB) parameters allowed for the calculation of an overall PSBB Index, ranging from 0-14.
  
  
  RESULTS
  Among the evaluated 2530 participants, 161 died over the unweighted median follow-up period of 70.0 months. After adjustment, for every 1 increase in the overall PSBB index score,participants had a 15% reduced risk of all-cause mortality (HR = 0.85; 95% CI: 0.76-0.96). After adjustment, the Behavioral Index (HR = 0.73; 95% CI: 0.60-0.88) and the Socioeconomic Index(HR = 0.82; 95% CI: 0.68-0.99) were significant, but the Psychological Index (HR = 0.67; 95%CI: 0.29-1.51) and the Biological Index (HR = 1.03; 95% CI: 0.89-1.18) were not.
  
  
  CONCLUSIONS
  Those with a worse PSBB score had an increased risk of all-cause mortality.Promotion of concurrent health behaviors may help to promote overall well-being and prolong survival.
authors.affiliation: Jackson Heart Study Vanguard Center of Oxford, Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Loprinzi
authors.affiliation: Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Davis
keywords: Behavior; Biological; Epidemiology; Health; Psychology; Survival