Socioeconomic status has an impact on premature mortality, shows Chennai study

While the association of premature mortality with smoking and alcohol is well established, a recent study of nearly half a million adults in Chennai shows that social inequality has an important role in mortality as well.

A paper published in the recent volume of Nature Health provides results from a large, prospective study among over 5,00,000 men and women aged 35 years and over in Chennai and establishes the joint association of education, adult socioeconomic status, smoking, and alcohol drinking with mortality before the age of 70 years.

One in 10 men and one in three women in the study had had no schooling. Even among those who did not smoke or drink, those with no schooling had about three times the death rate in middle age (35–69 years) of those with tertiary education. Few women smoked or drank, but men who both smoked and drank had about double the death rate in middle age than those with neither habit. Men with no schooling were three times as likely to smoke or drink as men with tertiary education, and smoking and drinking exacerbated the social inequalities leading to premature mortality, the study said. Researchers said more than 52,000 premature deaths were recorded during follow-up.

The study was jointly done by the Epidemiological Research Centre (ERC), Chennai, and University of Oxford, the UK. The Indian investigator, Gajalakshmi Vendhan, of the ERC, explained: “We used education as a correlate of social class. Apart from smoking and drinking, the correlates of education that are directly or indirectly responsible for its inverse association with mortality are largely unknown.” The researchers did not study caste, income, or access to healthcare, in particular. 

She further added: “Our study shows that in each education level, beedi smoking was associated with higher risk than cigarette smoking. Even though the study was done in Chennai, we feel the findings are relevant throughout India, and possibly Southeast Asia.” 

The study indicates that reducing premature mortality in India will take more than just creating deterrence for smoking and drinking alcohol. The researchers say that while there must be policies to promote regular health screenings/master check-ups above 50 years of age, these should go along with an increase in taxation on cigarettes and alcohol, but more importantly, focused attention to raising the educational level of all citizens is absolutely crucial.