Introduction: As the saying goes, "the economic base determines the superstructure". Not only that, but a person's economic base also reflects his social status to a certain extent. So to what extent can differences in Social Economic Status (SES) and lifestyle affect mortality?
Recently, a study titled "Educational Attainment and Lifestyle Risk Factors Associated With All-Cause Mortality in the US" revealed that lower socioeconomic status and unhealthy lifestyles are strongly associated with higher all-cause mortality (Figure 1).
Figure 1 Research findings (Source: JAMA Health Forum)
Over the past decade (even before COVID-19), there has been no trend toward longer life expectancy in The United States, largely due to external causes such as drugs, alcoholism, and suicide. In addition, socioeconomic inequality is also prominent in the United States, irregular lifestyles, exposure to high-risk environments of work, social pressure, access to health insurance, etc. are affecting people's physical and mental health. Among them, unhealthy lifestyle factors are more common in groups with low SES, and individuals with low SES also face higher mortality rates.
The team focused on data from 415764 U.S. adults in the 1997-2014 National Health Interview Survey, which included 55 percent of women and 45 percent of men; the average age was 49.4 years. In addition, 45 per cent had a low level of education, 27 per cent had a higher education level and the rest had a medium level of education.
First, the researchers analyzed the associations between alcohol consumption, smoking, body mass index (BMI), and physical activity and educational attainment,which indicates socioeconomic status. As can be seen from the table (Table 1), 55% of respondents have never smoked, 35% are healthy in weight, and 42% have a habit of physical exercise. Crucially, poor lifestyles such as smoking, excessive BMI (obesity), and lack of physical activity are more prevalent among people with low levels of education. Not only that, low levels of education are associated with an increase in mortality, with 187.4 per 10,000 deaths per year in lowly educated groups and 69.8 per 10,000 deaths per year among highly educated people.
Table 1 Characteristics of baseline participants stratified by sex and educational attainment
Table source: JAMA Health Forum
The researchers also studied the results of the cumulative interaction between educational attainment and various lifestyles (Table 2). In terms of alcohol consumption, the results showed an additive interaction among women, i.e. the coexistence of low levels of education and the highest drinking category (class III) resulting in an increase in the number of annual deaths by 85.0/000, while no such phenomenon was found in men.
In BMI, there is an additive interaction between men, i.e. the combination of low education and obesity leads to a 30.00/000 reduction in annual deaths; in women, there is no such phenomenon.
Second, in the association between educational attainment and smoking and physical exercise, both men and women showed cumulative interactions.
Table 2 Assess the effects of additive interactions between educational attainment and lifestyles on all-cause mortality
Table source: JAMA Health Forum
Another new finding is that the socioeconomic inequalities associated with all-cause mortality in men and women are largely caused by differences in lifestyles. In men, the association between low educational attainment and mortality was 30 percent mediated by smoking (different exposures), 27 percent by physical activity, 16 percent by alcohol consumption, and only 6 percent by excessive BMI (obesity). The findings for women were similar to those of men.
Taken together, the findings suggest that the socioeconomic inequalities (educational attainment) associated with all-cause mortality are mainly caused by smoking and lack of physical activity and drinking, while there is little independent association with high BMI (obesity). Public health interventions can significantly reduce mortality if public health interventions address smoking, physical inactivity, alcohol consumption, and the development of these behaviours in low socioeconomic status groups.
Putting aside the above discussion, we often hear the phrase "self-discipline is freedom" in life, and self-discipline is not only a strict requirement for self in a certain behavior, but also an attitude and way of life. For us ordinary people, no one likes to stand up to the beer belly, lose shape, develop good exercise habits, cultivate self-disciplined attitude to life, can make us more satisfied with their own state. Moreover, self-discipline has a "knock-on effect", and once you develop such a lifestyle, it will affect all aspects of your life. For example, in the workplace, you will be more engaged in your work and achieve satisfactory career achievements through long-term self-discipline; in terms of life schedules, you will not chase dramas and stay up late every day as soon as you get home, and a high degree of self-discipline will keep you physically and mentally healthy. Let's stay away from disease and embrace health together!
Written by | Guo Haijun
Typography | essay competition
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Resources:
[1] Puka K, Buckley C, Mulia N, et al. Educational Attainment and Lifestyle Risk Factors Associated With All-Cause Mortality in the US. JAMA Health Forum. 2022;3(4):e220401. doi:10.1001/jamahealthforum.2022.0401
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