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In many studies that have documented the presence of socioeconomic gradients in health status, this message has been clear: It is better to be rich than poor. However, the mechanism behind such health disparities remains uncertain. In a longitudinal study from London, researchers assessed how health behaviors are associated with socioeconomic status and mortality. Nearly 10,000 British civil servants were followed from 1985 to 2009.
After adjustments for sex and age, people in the lowest socioeconomic position had 1.6 times higher risk for all-cause mortality relative to those in the highest position. After adjustments for baseline health behaviors (smoking, alcohol intake, diet, and physical activity), the hazard ratio for all-cause mortality for low versus high socioeconomic position fell to 1.31. Furthermore, when health behaviors were controlled at baseline and longitudinally, the HR declined to 1.14 and was no longer statistically significant.
Stringhini S et al. Association of socioeconomic position with health behaviors and mortality. JAMA 2010 Mar 24/31; 303:1159.
Dunn JR. Health behavior vs the stress of low socioecomic status and health outcomes. JAMA 2010 Mar 24/31; 303:1199.
Comment
This study of the relations between socioeconomic position, health behaviors, and mortality is unique in controlling for health behaviors at baseline and longitudinally. The researchers found that disparities in mortality across the socioeconomic spectrum were largely explained by health behaviors — at least among these British civil servants with health insurance. It is tempting to conclude that individual predispositions or characteristics precede both unhealthy behaviors and socioeconomic status. Many would argue that social, financial, and other systemic factors heavily influence the adoption of particular health behaviors by individuals.