June 8, 1998 ANN ARBOR---Risky health behaviors such as smoking, drinking, lack of physical activity, and being overweight account for only a small part of the excess mortality among low-income and less educated Americans, according to a new University of Michigan study.
Scientists, policy makers and pundits have generally assumed that disadvantaged Americans have higher mortality rates primarily because they more often engage in risky health behaviors. However, this study shows that health risk behaviors account for only a small part of the excess mortality among Americans with low levels of income and education, according to Paula Lantz, assistant professor of health management and policy at the U-M School of Public Health.
Lantz's study, titled "Socioeconomic Factors, Health Behaviors and Mortality: Results from a Nationally-Representative Prospective Study of U.S. Adults," appears in the June 3 issue of the Journal of the American Medical Association.
The study investigated the association between high mortality rates, socioeconomic position, and four behavioral risk factors---cigarette smoking, alcohol consumption, physical activity and weight. Lantz and her colleagues examined the impact of education, income and these health behaviors on the risk of dying in the next 7.5 years in a national sample of 3,617 adults who were first interviewed in 1986.
The researchers found that those with low levels of income and education were significantly more likely both to engage in risky health behaviors and to die. For example, compared with people with annual family incomes over $30,000, those with incomes of less than $10,000 were over three times as likely to die, and those with incomes between $10,000 and $30,000 were more than twice as likely to die. The increased prevalence of health risk behaviors, however, did not explain the higher rate of age-adjusted mortality among those with lower incomes. "After taking baseline health status and personal health behaviors into account, we found that people with lower incomes still had a much higher risk of dying," Lantz said.
A combination of other factors associated with lower income likely play a greater role than personal lifestyle factors in explaining the elevated mortality risk. These include the greater chronic and acute stresses of daily life, decreased social supports, lower self-esteem, heightened levels of anger and hostility, and a decreased sense of control. Other key elements thought to be associated with high mortality rates among the disadvantaged include increased exposure to occupational and environmental health hazards, and lack of preventive medical care.
"Improving the health habits of Americans is a critical and important public health goal. However, health policies and interventions that primarily focus on individual health behaviors have limited potential for reducing socioeconomic disparities in mortality. This gap is due to more than lifestyle choices and therefore would persist even with improved health behaviors," Lantz said.
"The bottom line here is that income differences in mortality are due to a lot more than health risk behaviors. If we just focus on personal health behaviors in our policies and programs, we will not adequately address, much less reduce, the large economic and social inequalities in health that exist in this country."
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