TY - JOUR
T1 - Socioeconomic indicators of health inequalities and female mortality
T2 - a nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)
AU - Bailey, Katharine
AU - Ryan, Andy
AU - Apostolidou, Sophia
AU - Fourkala, Evangelia
AU - Burnell, Matthew
AU - Gentry-Maharaj, Aleksandra
AU - Kalsi, Jatinderpal
AU - Parmar, Max
AU - Jacobs, Ian
AU - Pikhart, Hynek
AU - Menon, Usha
PY - 2015/3/17
Y1 - 2015/3/17
N2 - Background: Evidence is mounting that area-level socioeconomic indicators are important tools for predicting
health outcomes. However, few studies have examined these alongside individual-level education. This nested
cohort study within the control arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening
(UKCTOCS) assesses the association of mutually adjusted individual (education) and area-level (Index of Multiple
Deprivation-IMD 2007) socioeconomic status indicators and all-cause female mortality.
Methods: Participants resident in England who had completed both baseline (Wave 1) and follow up (Wave 2)
questionnaires were included. Follow-up was through the Health and Social Care Information Centre with deaths
censored on 31st December 2012. IMD, education and a range of covariates were explored. Cox regression models
adjusted for all covariates were used. Sensitivity analysis using imputation was performed (1) including those with
missing data and (2) on the entire cohort who had completed the baseline questionnaire.
Results: Of the 54,539 women resident in England who completed both Wave 1 and Wave 2 questionnaires,
4,510 had missing data. The remaining 50,029 women were included in the primary analysis. Area-level IMD
was positively associated with all-cause mortality for the most deprived group compared to the least deprived
(HR=1.42, CI=1.14-1.78) after adjusting for all potential confounders. Sensitivity analyses showed similar results
with stronger associations in the entire cohort (HR=1.90, CI=1.68-2.16). The less educated an individual, the
higher the mortality risk (test for trend p=<0.001). However, the crude effect on mortality of having no formal
education compared to college/university education disappeared when adjusted for IMD rank (HR=1.08,
CI=0.93-1.26).
Conclusion: Women living in more deprived areas continue to have higher mortality even in this less deprived
cohort and after adjustment for a range of potential confounders.
AB - Background: Evidence is mounting that area-level socioeconomic indicators are important tools for predicting
health outcomes. However, few studies have examined these alongside individual-level education. This nested
cohort study within the control arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening
(UKCTOCS) assesses the association of mutually adjusted individual (education) and area-level (Index of Multiple
Deprivation-IMD 2007) socioeconomic status indicators and all-cause female mortality.
Methods: Participants resident in England who had completed both baseline (Wave 1) and follow up (Wave 2)
questionnaires were included. Follow-up was through the Health and Social Care Information Centre with deaths
censored on 31st December 2012. IMD, education and a range of covariates were explored. Cox regression models
adjusted for all covariates were used. Sensitivity analysis using imputation was performed (1) including those with
missing data and (2) on the entire cohort who had completed the baseline questionnaire.
Results: Of the 54,539 women resident in England who completed both Wave 1 and Wave 2 questionnaires,
4,510 had missing data. The remaining 50,029 women were included in the primary analysis. Area-level IMD
was positively associated with all-cause mortality for the most deprived group compared to the least deprived
(HR=1.42, CI=1.14-1.78) after adjusting for all potential confounders. Sensitivity analyses showed similar results
with stronger associations in the entire cohort (HR=1.90, CI=1.68-2.16). The less educated an individual, the
higher the mortality risk (test for trend p=<0.001). However, the crude effect on mortality of having no formal
education compared to college/university education disappeared when adjusted for IMD rank (HR=1.08,
CI=0.93-1.26).
Conclusion: Women living in more deprived areas continue to have higher mortality even in this less deprived
cohort and after adjustment for a range of potential confounders.
KW - Education
KW - IMD
KW - Mortality
KW - Socioeconomic
KW - UKCTOCS
UR - http://www.scopus.com/inward/record.url?scp=84928238962&partnerID=8YFLogxK
U2 - 10.1186/s12889-015-1609-5
DO - 10.1186/s12889-015-1609-5
M3 - Article (Academic Journal)
C2 - 25848938
AN - SCOPUS:84928238962
SN - 1471-2458
VL - 15
JO - BMC Public Health
JF - BMC Public Health
M1 - 253
ER -