Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population-based cohort study

Abstract

Background Among older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality. Methods We used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project; baseline recruitment in 2005–2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES; educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using “change-in-estimate method”. Results 1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality. Conclusion Psychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.

Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors

“…Cancer survival is known to vary by socio-economic advantage/disadvantage [6][7][8][9][10][11] with this difference partly explained by variations in stage at diagnosis and treatment differences [6]. Recent evidence suggests that psychosocial factors including living alone, being unmarried and higher levels of depression can also negatively impact survival [12,13]. Identifying whether socio-economic and demographic disparities also influence QoL outcomes for cancer survivors and the potential drivers of any differences can inform the type of survivorship care that should be directed to different cancer survivors to help ensure equitable outcomes [14].…”

Living alone and all-cause mortality in community-dwelling adults: A systematic review and meta-analysis

“…Three studies included only adults younger than 75 years old 24 , 25 , 26 ; one study only included only adults older than 75 years old 21 ; and the remainder included both. 10 , 11 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Three studies reported the association between living alone and mortality separately for adults younger than 75 years and older than 75 years. 28 , 31 , 33 One study reported the association between living alone and mortality separately for the adults younger and older than 65 years.…”

“… 28 , 31 , 33 One study reported the association between living alone and mortality separately for the adults younger and older than 65 years. 11 Two studies included only men 30 , 32 and one only women 27 ; among the mixed-sex cohorts, eight reported the association between living alone and mortality separately for males and females. 24 , 25 , 30 , 31 , 33 , 34 , 35 Most studies reported their outcomes with HR 11 , 24 , 25 , 27 , 28 , 29 , 30 , 32 , 33 , 36 , 37 ; four with RR 23 , 30 , 31 , 34 and four with OR.…”

The Contribution of Material, Behavioral, Psychological, and Social-Relational Factors to Income-Related Disparities in Cardiovascular Risk Among Older Adults

“…For instance, Stringhini et al 14 reported that low social integration (eg, family relations, positive/negative support, and loneliness) accounted for a partial degree of cumulative socioeconomic disparities in CVD mortality among British men older than 50 years. Khalatbari-Soltani et al 15 revealed that being unmarried and living alone were both associated with a higher risk of CVD mortality among lower-income men older than 70 years in Australia.…”