Social inequalities in overall and cause specific mortality in Seychelles.

Author(s) Silvia Stringhini1, Valentin Rousson2, Bharathi Viswanathan3, Jude Gedeon 4, Fred Paccaud 5, Pascal Bovet6.
Affiliation(s) 1IUMSP, CHUV, Lausanne, Switzerland, 2IUMSP, CHUV, Lausanne, Switzerland, 3Ministry of Health, Ministry of Health, Victoria, Seychelles, 4Ministry of Health, Ministry of Health, Victoria, Seychelles, 5IUMSP, CHUV, Lausanne, Switzerland, 6IUMSP, CHUV, Lausanne, Switzerland.
Country - ies of focus Seychelles
Relevant to the conference tracks Social Determinants and Human Rights
Summary Low socioeconomic status is associated with higher risk of overall and cause specific mortality in a country of the African Region.
Background Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data.
Objectives This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state.
Methodology All deaths have been medically certified for more than two decades. SES and other health risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was assessed using the same questions in the three surveys.
Results During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a larger mortality risk overall (HR=1.80; 95% CI: 1.24-2.62), CVD (HR=1.95; 1.04-3.65) and larger non-cancer/non-CVD (HR=2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR=1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained 25%, 11% and 19% of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality, respectively.
Conclusion In this population-based study assessing social inequalities in mortality in the African region, low SES was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect the poor in low and middle income countries.

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