Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study.
Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study.
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DOI：
10.1016/s2468-2667(23)00153-6
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发表时间：
2023-09
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影响因子：
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通讯作者：
Tapia-Conyer R
中科院分区：
文献类型：
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作者：
Addey T;Alegre-Díaz J;Bragg F;Trichia E;Wade R;Santacruz-Benitez R;Ramirez-Reyes R;Garcilazo-Ávila A;Gonzáles-Carballo C;Bello-Chavolla OY;Antonio-Villa NE;Aguilar-Ramirez D;Friedrichs LG;Lewington S;Peto R;Collins R;Berumen J;Emberson JR;Kuri-Morales P;Tapia-Conyer R
据报道，不同人群的成人死亡率存在社会不平等，但墨西哥没有大规模的前瞻性证据。我们的目标是量化墨西哥城成年人死亡率的社会不平等，包括教育不平等。墨西哥城前瞻性研究在 1998 年至 2004 年间招募了 15 万名墨西哥城 35 岁以上成年人。对参与者的具体原因死亡率进行了随访，直至 2021 年 1 月 1 日。 Cox 回归分析得出了 35-74 岁之间与教育相关的死亡率比 (RR)，并在探索性分析中检查了生活方式和相关危险因素的中介作用。在 143 478 名 35-74 岁的参与者中，教育程度与过早死亡呈很强的负相关。与受过高等教育的参与者相比，调整年龄和性别后，未受过教育的人的死亡率约为两倍（RR 1.84 [95% CI 1.71-1.98]），相当于预期寿命低约6年，RR分别为1.78（1.67-1.90）、1.62（1.53-1.72）和1.34（1.25-1.42）在初级不完全、初级完全的参与者中 和中等教育。受教育程度与肾脏疾病和急性糖尿病危象（未受过高等教育与受过高等教育相比，RR 3.65 [95% CI 3.05-4.38]）和传染病（2.67 [2.00-3.56]）导致的死亡关系最为密切，但受教育程度较低的所有特定原因导致的死亡率明显较高。生活方式因素（吸烟、饮酒、休闲时间体力活动）和相关生理相关因素（肥胖、糖尿病、血压）占教育与过早死亡关联的 84%。在墨西哥人口中，成人过早死亡率存在明显的教育不平等，这似乎主要是由生活方式和相关风险因素造成的。减少这些风险因素的有效干预措施可以减少不平等，并对过早死亡产生重大影响。威康信托基金会、墨西哥卫生部、墨西哥国家科学技术委员会、英国癌症研究中心、英国心脏基金会和英国医学研究委员会人口健康研究单位
Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aim to quantify social, including educational, inequalities in mortality among adults in Mexico City. The Mexico City Prospective Study recruited 150 000 adults aged 35+ years from Mexico City between 1998 and 2004. Participants were followed-up until 1 January 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors. Among 143 478 participants aged 35-74, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1.84 [95% CI 1.71-1.98]), equivalent to approximately 6 years lower life expectancy, with RR of 1.78 (1.67-1.90), 1.62 (1.53-1.72) and 1.34 (1.25-1.42) among participants with incomplete primary, complete primary and secondary education, respectively. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3.65 [95% CI 3.05-4.38] for none vs. tertiary education) and from infectious disease (2.67 [2.00-3.56]), but there was an apparent higher rate of death from all specific causes studied with lower education. Lifestyle factors (smoking, alcohol drinking, leisure time physical activity) and related physiological correlates (adiposity, diabetes, blood pressure) accounted for 84% of the association of education with premature mortality. In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality. Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit