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Journal of Public Health Advance Access published online on March 10, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp015
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Impact of socioeconomic, behavioral and clinical risk factors on mortality


Kimberly Rask, Professor of Health Policy and Management
Emily O'Malley, Statistician
Benjamin Druss, Professor of Health Policy and Management

Rollins School of Public Health, Health Policy and Management, 1518 Clifton Road, Rm 636, Atlanta, GA 30322, USA


Address correspondence to Kimberly Rask, E-mail: krask{at}emory.edu


  Abstract

This study investigates the relative contributions of socioeconomic status (SES), behavioral and clinical risk factors on mortality. The Third National Health and Nutrition Survey Linked Mortality File was used to examine the association of SES (race, insurance, education, income), behavioral (smoking, obesity, physical activity), and clinical (elevated blood pressure, triglyceride level, lipid levels, C-reactive protein (CRP)) risk factors with 6–12-year all-cause mortality. Respondents were stratified by known chronic diseases into one of the following categories: no chronic disease, non-cardiovascular chronic disease, cardiovascular disease, and diabetes. The overall weighted mortality rate was 9.5% with the highest mortality rate among diabetics. Race, insurance coverage, income, smoking status, inadequate physical activity, elevated blood pressure and elevated CRP were independently associated with mortality in the overall population. When stratified by chronic disease, SES factors remained associated with mortality, most strongly in the healthy population. Current smoking and inadequate physical activity were also associated with mortality across disease groups while clinical risk factors were less consistent. SES factors, health behaviors and clinical risk factors were all associated with mortality even when baseline health status and chronic diseases are taken into account. Efforts to reduce mortality will require a multi-faceted approach incorporating healthy behaviors and accessible health care systems in addition to clinical advances

Keywords: chronic disease, individual behavior, mortality


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