Journal Article

Individual- and Area-Level Socioeconomic Status Variables as Predictors of Mortality in a Cohort of 179,383 Persons

Kyle Steenland, Jane Henley, Eugenia Calle and Michael Thun

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 159, issue 11, pages 1047-1056
Published in print June 2004 | ISSN: 0002-9262
Published online June 2004 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwh129
Individual- and Area-Level Socioeconomic Status Variables as Predictors of Mortality in a Cohort of 179,383 Persons

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The authors have studied whether area-level socioeconomic status predicts mortality independently of individual-level socioeconomic status in 179,383 persons in the American Cancer Society Nutrition Cohort, followed for mortality from 1992 to 2000 (17,383 deaths). They used an area-level variable based on census blocks that was an average of home value, income, education, and occupation. Education was the individual-level socioeconomic status variable. The authors studied socioeconomic status-mortality trends with each socioeconomic status variable adjusted for the other. For all causes, an individual’s education was strongly and inversely associated with mortality; a weak but significant inverse trend was also present for area-level socioeconomic status. A similar pattern was seen for all-vascular disease. For all cancers, there was again a significant inverse trend with education but no trend with area-level socioeconomic status. Adjustment for conventional (non-socioeconomic status) individual-level risk factors diminished the effect of both socioeconomic status variables, although significant trends remained for men between education and all-cause, all-cancer, and all-vascular disease mortality. Study data indicate that the predictive value of area-level socioeconomic status variables varies by cause of death but is less important than individual-level socioeconomic status variables. Multivariate models that consider socioeconomic status as a potential confounder may not need to consider area-level socioeconomic status if data are available on individual-level education.

Keywords: cohort studies; heart diseases; mortality; multilevel model; social class; Abbreviation: ICD-9, International Classification of Diseases, Ninth Revision.

Journal Article.  5343 words. 

Subjects: Public Health and Epidemiology

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