Low socioeconomic status may be associated with substantial reductions in life expectancy and should be regarded as a major risk factor for ill health and early death in national and global health policies, according to a recently published study in The Lancet.

The study compared socioeconomic status with the seven major risk factors identified by the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) – harmful use of alcohol, insufficient physical activity, current tobacco use, high blood pressure, intake of salt or sodium, diabetes and obesity – also called the 25x25 risk factors after the WHO’s 25x25 initiative, a plan to cut mortality due to NCDs by 25 percent by 2025.

In this multicohort study – the first to compare the impact of low socioeconomic status with other major risk factors – researchers conducted a meta-analysis of individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25x25 risk factors and mortality, for a total population of 1,751,479 patients (54 percent women) from the United Kingdom, France, Switzerland, Portugal, Italy, the U.S. and Australia.

Results showed that low socioeconomic status was associated with reduced life expectancy of 2.1 years, similar to being inactive (2.4 years). Comparatively, high blood pressure, obesity and high alcohol consumption were associated with smaller reductions in life expectancy (1.6, 0.7 and 0.5 years, respectively) than low socioeconomic status. The greatest reductions were for smoking and diabetes (4.8 and 3.9 years, respectively).

“The finding that socioeconomic status is associated with death risk independently of conventional risk factors suggests that both socioeconomic adversity and 25x25 risk factors should be targeted by health strategies,” said lead author Silvia Stringhini, PhD.

In an accompanying editorial, Martin Tobias, MD, explains that “Whatever the exact effect and impact of low social rank on the health of individuals and populations might be, the authors’ key message is clear: social rank deserves consideration alongside the established 25x25 risk factors.” He adds that “the United Nations’ Sustainable Development Goals … provide a timely opportunity to go beyond the WHO 25x25 goal and place social determinants squarely at the centre of sustainable development.”

Keywords: Alcohol Drinking, Alcohols, Australia, Diabetes Mellitus, Exercise, France, Health Policy, Hypertension, Italy, Life Expectancy, Obesity, Portugal, Prospective Studies, Research Personnel, Risk Factors, Smoking, Social Class, Sodium, Sodium Chloride, Dietary, Switzerland, United Kingdom, United Nations, United States

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