Health Behaviors More Important than Socioeconomic Status

Many studies have reported that socioeconomic status is a predictor of morbidity & mortality. Now, a large-scale, longitudinal study asserts that the association may be more related to health behaviors than socioeconomic status. The study, published in the Journal of the American Medical Association (JAMA), reports that assessment of health behaviors over time diminishes the association between socioeconomic status & mortality.

The present study makes use of information from the Whitehall II study — a long-term follow-up study of over 10,000 British civil servants aged 35 to 55 years. Information was collected from 1985 until April 2009. Of the 9590 men & ladies included in the JAMA evaluation, there were 654 deaths in the work of the follow-up period. To assess the contribution that health behaviors have towards the association between socioeconomic status & mortality, the authors used civil service employment grade as an indicator of socioeconomic status, & measured health behaviors — smoking, alcohol consumption, diet, & physical activity — at 4 points in the work of follow-up.
Overall, the risk of all-cause mortality was 1.6 times higher in the lowest socioeconomic status group versus the highest, amounting to 1.94 deaths per 1000 person-years. However, this association between socioeconomic status & death was weakened when adjusted for health behaviors: 42% weaker when only baseline health behaviors were thought about & 72% weaker when time-dependent health behaviors were thought about. Adjusting for health behaviors also decreased the association between socioeconomic status & specific causes of death. When assessed only at baseline, the association was weakened by 29% for cardiovascular mortality, versus 45% when health behaviors were assessed over time. Similarly, the association between socioeconomic status & noncardiovascular & noncancer mortality decreased by 61% when health behaviors were analyzed at baseline versus 94% when thought about over time.
These differences in associations of mortality reflect the effect of lifestyle changes on all-cause mortality. Likewise, the effect of diet was increased from 7% to 17% when health behaviors were thought about at baseline versus over time, respectively. The corresponding explanatory power of physical activity on all-cause mortality increased from 5% to 21%, & that of alcohol consumption increased from 3% to 12%. The role of smoking did not change the association between socioeconomic status & all-cause mortality.
The prevalence of unhealthy behaviors is high among lower socioeconomic groups, & they contribute to increased morbidity & mortality. Until this study, most evaluations of socioeconomic status & morbidity & mortality only assess health behaviors at baseline; this study emphasizes the effect of changing health behaviors on mortality, irrespective of socioeconomic status. Health behaviors likely play a bigger role than socioeconomic status in all-cause mortality, according to the authors.
However, inequalities in health behaviors, policies & interventions exist, which are correlated to socioeconomic status. So, which comes first? Are health behaviors socially patterned & predetermined , leading to maintenance of a positive socioeconomic status? Or, do inadequate health policies & interventions among low socioeconomic groups lead to poor health behaviors? Does basically the stress associated with having low socioeconomic status influence poor health behaviors? Lots of recent studies describe associations between low socioeconomic status & higher all-cause mortality, as well as specific cancer-related deaths, kidney transplant failure & mortality, & heart transplant rejection, but fail to identify the root of the association.
Since the current analysis of the association between socioeconomic status & mortality appears to be attenuated by changing health behaviors, health policies & interventions among low socioeconomic groups ought to focus on health schooling & affecting change in populations that have notoriously poor health behaviors.