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Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort

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Abstract

Objectives To investigate the independent associations between occupational and educational based measures of socioeconomic status (SES) and cause-specific mortality, and the extent to which potentially modifiable risk factors smoking and body mass index (BMI) explain such relationships. Design, setting and participants Prospective population study of 22,486 men and women aged 39–79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993–1997 and followed up for total mortality using death certification to 2006. Main results In men a strong inverse relationship was found between social class and all cause, cardiovascular and cancer mortality, with relative risk of social class V compared to I of 2.21 for all cause mortality (95% CI 1.54–3.17, P < 0.001). This was attenuated but not abolished after adjusting for modifiable risk factors, smoking and BMI, with relative risk of social class V compared to I for all cause mortality of 1.92 (95% CI 1.34–2.77, P < 0.001). A similar, but smaller effect was seen in women. Educational status was not associated with mortality independently of social class. Conclusions Social class and education are not necessarily interchangeable measures of SES. Some but not all of the socioeconomic differential in mortality can be explained by potentially modifiable risk factors smoking and BMI. Further understanding of the mechanisms underlying the association of each socioeconomic indicator with specific health outcomes is needed if we are to reduce inequalities in health.

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Abbreviations

BMI:

Body mass index

EPIC-Norfolk:

European Prospective Investigation of Cancer and Nutrition

SES:

Socioeconomic status

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Acknowledgments

We thank the participants and general practitioners who took part in the study and the staff of EPIC-Norfolk. Funding: EPIC-Norfolk is supported by research programme grant funding from the Cancer Research Campaign and Medical Research Council with additional support from the Stroke Association, British Heart Foundation, and Research Into Ageing. Contributors: KTK, SB, and NW are principal investigators in the EPIC-Norfolk population study. SB is responsible for the dietary measurements and analyses. RL is responsible for data management and computing and data linkages for post coding. EM conducted the data analyses and wrote the paper with KTK with contributions from other coauthors.

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Authors and Affiliations

  1. Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Room 311, Wort’s Causeway, Cambridge, CB1 8RN, UK

    Emily McFadden, Robert Luben, Nicholas Wareham, Sheila Bingham & Kay-Tee Khaw

  2. MRC Dunn Nutrition Unit, Cambridge, UK

    Sheila Bingham

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  1. Emily McFadden
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Correspondence to Emily McFadden.

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McFadden, E., Luben, R., Wareham, N. et al. Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol 23, 511–522 (2008). https://doi.org/10.1007/s10654-008-9267-x

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