The contribution of behavioural and metabolic risk factors to socioeconomic inequalities in mortality: the Italian Longitudinal Study

OBJECTIVES: The aim of this study was to assess social inequalities in overall mortality in a representative sample of the Italian population, and to evaluate the contribution of behavioural and metabolic risk (BMF) factors to these inequalities. METHODS: 85,308 participants aged 25-74 years from the Italian Longitudinal Study were included in the study population and followed up for mortality (1999-2012). Level of education was used as a proxy for socioeconomic status. The contribution of BMF was estimated assessing the attenuation of the risk by education produced by the inclusion of BMF in regression model. RESULTS: Men with the lowest education had 62% and women had 57% greater risk of dying than those with the highest education. Among men, adjustment for BMF produced an attenuation of the mortality risk between extreme classes of education by 22%, while among women the risk attenuation was 7%. CONCLUSIONS: Large educational differences in mortality were observed for both men and women. BMF reduced by approximately 20% differences in mortality relative risk between extreme classes of education in men. In contrast, a very low contribution was observed in women.