Evidence is mounting that area-level socioeconomic indicators are important tools for predicting health outcomes. However, few studies have examined these alongside individual-level education. This nested cohort study within the control arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) assesses the association of mutually adjusted individual (education) and area-level (Index of Multiple Deprivation-IMD 2007) socioeconomic status indicators and all-cause female mortality

Apostolidou, S

Bailey, K

Burnell, M

Fourkala, E

Gentry-Maharaj, A

Jacobs, I

Kalsi, J

Menon, U

Parmar, M

Pikhart, H

Ryan, A

BMC Public Health

English

PubMed

Katharine Bailey

Andy Ryan

Sophia Apostolidou

Evangelia Fourkala

Matthew Burnell

Aleksandra Gentry-Maharaj

Jatinderpal Kalsi

Max Parmar

Ian Jacobs

Hynek Pikhart

Usha Menon

Crossref

Socioeconomic indicators of health inequalities and female mortality: a nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Background: Evidence is mounting that area-level socioeconomic indicators are important tools for predicting health outcomes. However, few studies have examined these alongside individual-level education. This nested cohort study within the control arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) assesses the association of mutually adjusted individual (education) and area-level (Index of Multiple Deprivation-IMD 2007) socioeconomic status indicators and all-cause female mortality. Methods: Participants resident in England who had completed both baseline (Wave 1) and follow up (Wave 2) questionnaires were included. Follow-up was through the Health and Social Care Information Centre with deaths censored on 31st December 2012. IMD, education and a range of covariates were explored. Cox regression models adjusted for all covariates were used. Sensitivity analysis using imputation was performed (1) including those with missing data and (2) on the entire cohort who had completed the baseline questionnaire. Results: Of the 54,539 women resident in England who completed both Wave 1 and Wave 2 questionnaires, 4,510 had missing data. The remaining 50,029 women were included in the primary analysis. Area-level IMD was positively associated with all-cause mortality for the most deprived group compared to the least deprived (HR=1.42, CI=1.14-1.78) after adjusting for all potential confounders. Sensitivity analyses showed similar results with stronger associations in the entire cohort (HR=1.90, CI=1.68-2.16). The less educated an individual, the higher the mortality risk (test for trend p=&lt;0.001). However, the crude effect on mortality of having no formal education compared to college/university education disappeared when adjusted for IMD rank (HR=1.08, CI=0.93-1.26). Conclusion: Women living in more deprived areas continue to have higher mortality even in this less deprived cohort and after adjustment for a range of potential confounders.</p

Bailey, Katharine

Ryan, Andy

Apostolidou, Sophia

Fourkala, Evangelia

Burnell, Matthew

Gentry-Maharaj, Aleksandra

Kalsi, Jatinderpal

Parmar, Max

Jacobs, Ian

Pikhart, Hynek

Menon, Usha

Explore Bristol Research

Socioeconomic indicators of health inequalities and female mortality:a nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

UCL Discovery

Adolescence and the social determinants of health.

All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts,

Analysing recent socioeconomic trends in coronary heart disease mortality in England, 2000–2007: a population modelling study.

Cancer surpasses heart disease as leading cause of death for all but the very elderly.

Coronary heart disease statistics: A compendium of health statistics

Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention. Circ Cardiovasc Interv.

Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med.

Does the variation in the socioeconomic characteristics of an area affect mortality?

Fair Society, Healthy Lives. Strategic Review of Health Inequalities

Health in austerity: hard decisions for hard times. Lancet. 2014;383 (9918):670. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges •

Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials.

Income inequality and population health: a review and explanation of the evidence. Soc Sci Med.

Income inequality, social cohesion and the health status of populations: the role of neo-liberalism. Soc Sci Med.

Increasing mortality differentials by residential area level of poverty : Britain 1981–1997. Soc Sci Med.

Index of Multiple Deprivation Welsh

Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study.

Individual-and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons.

Ireland Multiple Deprivation Measure 2010: Northern Ireland Statistics and Research Agency;

Lifestyles and Behaviours-Drinking Habits Amongst Adults,

lung and colorectal cancer incidence and survival in South Thames Region, 1987–1992: the effect of social deprivation.

Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health.

Mortality and educational level among diabetic and non-diabetic population in the Turin Longitudinal Study: a 9-year follow-up.

Mortality decline and widening social inequalities.

Mortality improvement by socio-economic circumstances in

National trends in educational differentials in mortality.

Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study.

Neighborhoods and health.

Neighbourhood deprivation and health: Does it affect us all equally?

Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol.

Out of term population statistics for output areas in England and

Phantom of the area : Poverty-area residence and mortality in the United States.

Recruitment to multicentre trials-lessons from UKCTOCS: descriptive study. Br Med J.

Six employment conditions and health inequalities: a descriptive overview.

Smoking Habits Amongst Adults,

Social inequalities in female mortality by region and by selected causes of death,

Social inequalities in health: next questions and converging evidence. Soc Sci Med.

Social-Class Inequality in Mortality from 1921 to 1972 in England and Wales.

Socioeconomic context in area of living and risk of myocardial infarction: results from Stockholm Heart Epidemiology Program (SHEEP).

Socioeconomic status and cancer survival in Ontario.

Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome.

Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s.

Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen Male Study.

Socioeconomic status and risk of diabetes-related mortality in the U.S. Public Health Rep.

Socioeconomic status, structural and functional measures of social support, and mortality: The British Whitehall II Cohort Study,

Super Output Areas Explained [cited

The association between deprivation and hospital mortality for admissions to critical care units in England.

The English Indices of Deprivation

The impact of socioeconomic status on stage of cancer at diagnosis and survival: a population-based study in Ontario. Canada Cancer.

The increasing disparity in mortality between socioeconomic groups in the United States,

The Index of Multiple Deprivation

The relationship between socioeconomic status and health: a review of the literature. Milbank Q.

The size of mortality differences associated with educational level in nine industrialized countries.

Trends in educational inequalities in mortality, seven types of cancers,

Variations in life expectancy between rural and urban areas of England,

Socioeconomic indicators of health inequalities and female mortality: a nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Abstract

Similar works

Full text

Available Versions

Crossref

Explore Bristol Research

UCL Discovery

Explore Bristol Research