The European Journal of Public Health Advance Access originally published online on June 14, 2007
The European Journal of Public Health 2008 18(1):38-43; doi:10.1093/eurpub/ckm051
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Health Inequalities |
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
Mikko Laaksonen1, Kirsi Talala2, Tuija Martelin3, Ossi Rahkonen1, Eva Roos4, Satu Helakorpi2, Tiina Laatikainen2 and Ritva Prättälä2
1 Department of Public Health, University of Helsinki, Finland
2 Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Finland
3 Department of Health and Functional Capacity, National Public Health Institute, Finland
4 Folkhälsan Research Center, Finland
Correspondence: Mikko Laaksonen, PhD, Department of Public Health, P.O. Box 41, FIN-00014, University of Helsinki, Finland. tel: +358 9 191 27569, fax: +358 9 191 27570, e-mail: mikko.t.laaksonen{at}helsinki.fi
Received December 13, 2006 , accepted May 14, 2007
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 avtivity, 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.
Keywords: cardiovascular diseases, health behaviours, mortality, socioeconomic factors