Journal
AMERICAN JOURNAL OF PUBLIC HEALTH
Volume 106, Issue 3, Pages 470-477Publisher
AMER PUBLIC HEALTH ASSOC INC
DOI: 10.2105/AJPH.2015.302984
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Funding
- Societe Francophone de Diabetologie
- Assistance Publique of Paris Hospitals, France
- Commonwealth Dept of Health and Aged Care
- Abbott Australasia Pty Ltd
- Alphapharm Pty Ltd
- AstraZeneca
- Aventis Pharmaceutical
- Bristol-Myers Squibb Pharmaceuticals
- Eli Lilly (Aust) Pty Ltd
- GlaxoSmithKline
- Janssen-Cilag (Aust) Pty Ltd
- Merck Lipha s.a.
- Merck Sharp Dohme (Aust)
- Novartis Pharmaceutical (Aust) Pty Ltd
- Novo Nordisk Pharmaceutical Pty Ltd
- Pharmacia and Upjohn Pty Ltd
- Pfizer Pty Ltd
- Roche Diagnostics
- Sanofi Synthelabo (Aust) Pty Ltd
- Servier Laboratories (Aust) Pty Ltd
- BioRad Laboratories Pty Ltd
- HITECH Pathology Pty Ltd
- Australian Kidney Foundation
- Diabetes Australia, Diabetes Australia (Northern Territory)
- Queensland Health
- South Australian Department of Human Services
- Tasmanian Department of Health and Human Services
- Territory Health Services
- Victorian Department of Human Services
- Victorian OIS program
- Health Department of Western Australia
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Objectives. To determine the association of socioeconomic position indicators with mortality, without and with adjustment for modifiable risk factors. Methods. We examined the relationships of 2 area-based indices and educational level with mortality among 9338 people (including 8094 younger than 70 years at baseline) of the Australian Diabetes Obesity and Lifestyle (AusDiab) from 1999-2000 until November 30, 2012. Results. Age-and gender-adjusted premature mortality (death before age 70 years) was more likely among those living in the most disadvantaged areas versus least disadvantaged (hazard ratio [HR] = 1.48; 95% confidence interval [CI] = 1.08, 2.01), living in inner regional versus major urban areas (HR = 1.36; 95% CI = 1.07, 1.73), or having the lowest educational level versus the highest (HR = 1.64; 95% CI = 1.17, 2.30). The contribution of modifiable risk factors (smoking status, diet quality, physical activity, stress, cardiovascular risk factors) in the relationship between 1 area-based index or educational level and mortality was more apparent as age of death decreased. Conclusions. The relation of area-based socioeconomic position to premature mortality is partly mediated by behavioral and cardiovascular risk factors. Such results could influence public health policies.
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