Socioeconomic and Educational Inequities as Independent Predictors for Mortality in a Developing Country: A Cohort Study in San Francisco, Chile
Background: The socioeconomic position (SEP) and educational level of individuals have an inverse correlation with mortality in developed societies.
Aim: To assess in a society undergoing a socioeconomic transition, the mortality risk associated to a low SEP (a combination of education and income, scale 0-25 points, reference > 10 points) and low education (education years, reference > 8 years), adjusting for other known risk factors.
Material and methods: In this prospective cohort study, a random sample of 920 subjects, living in San Francisco de Mostazal, Chile, aged more than 20 years (395 males) was examined for the first time in 1997-1999 and re-examined in 2005-2006. All had information about economic household income and level of education. A Cox regression model was used to evaluate the association between mortality and socioeconomic measures.
Results: The crude mortality hazard ratio (HR) was 3.34 (95% confidence interval (CI) 2.88-3.87) and 6.05 (95% CI 5.04-7.26) for low SEP and low educational level, respectively. After adjusting for age, gender, hypertension, diabetes, dyslipidemia, abdominal obesity, smoking, alcohol intake and family history of cardiovascular disease, the figures were 1.23 (95% CI 1.04-1.43) and 1.54 (95% CI 1.23-1.85) for low SEP and low educational level, respectively.
Conclusions: In a society in socioeconomic transition, low SEP and especially low educational levels are risk factors for mortality even after adjusting for known mortality risk factors.