Abstract 13881: Social Inequalities in All Cause and Cause Specific Mortality in a Country of the African Region
Background: Studies in high income countries consistently show low socioeconomic status (SES) to be associated with a higher mortality risk. Because of limited availability of mortality data this issue remains largely unexplored in low and middle income countries, particularly in the African region.
Methods: Three independent population-based surveys of cardiovascular risk factors were conducted in representative samples of all adults aged 25-64 years in the Seychelles, a small island state located east to Kenya, in 1989 (N=1081), 1994 (N=1067) and 2004 (N=1255). All deaths are recorded in Seychelles and survey data were linked with vital statistics for the period 1989-2012. Analyses were based on 3246 participants with complete data on all risk factors considered for the study.
Results: Over a mean follow-up for mortality of 15.0 years (range 0-24 years), 523 participants died (mortality rate 10.8 per 1000 person-years). Main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a greater risk of all-cause (HR=1.80, 95% CI: 1.24; 2.62) and cardiovascular (HR=1.95, 95% CI: 1.04; 3.65) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR=1.44, 95% CI: 0.76; 2.75 in the low versus high SES group). Common lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained about one fourth of the association between low SES and all-cause mortality and 11% of that between low SES and CVD mortality.
Conclusions: In the first population-based study to assess social inequalities in mortality in the African region, SES was a strong predictor of all-cause and CVD mortality. Our findings support the view that the burden of non-communicable diseases (and their risk factors) is shifting towards the poor in low and middle income countries.
- © 2013 by American Heart Association, Inc.