Health inequality shows in two-decade SA study

A report card of Adelaide’s ‘working class’ suburbs confirms strong connections between longevity and socioeconomic factors.

Preventable cardiovascular disease continues to prematurely claim the majority of lives in Adelaide industrial suburbs – despite awareness of healthy diet, moderate exercise and cutting out smoking and alcohol, the Flinders University research shows.

Despite Australia’s high standards of living, socioeconomic factors still disproportionally lower life expectancy levels for people of all ages in Adelaide’s west and north, analysis of data from the North West Adelaide Health Study (NWAHS) shows.

The study is one of the first longitudinal community studies combining sociodemographic, behavioural, metabolic and chronic disease, reported mental health, and use of medicines and health services.

Overall there were 614 deaths among the 4033 participants aged 18-90 years followed between 1999-2000 and 2018 – a crude death rate of 9.6 per 1000 person-years – with:

  • Socioeconomic factors (employment, income, education and where you live in the ‘Socio-Economic Indexes for Areas’) the most important of all-cause mortality, particularly for younger people, and those aged over 65 years.
  • Behavioural factors also contributed to premature death in the older cohort.
  • Women appeared more aware of their health, with generally better outcomes than men, especially in the older age group (≥65 years). However, women have higher rates of stress, anxiety, depression, non-fatal chronic conditions, and are more likely to encounter violence than men.
  • Surprisingly, being overweight (BMI 25kg-29.9kg) did not appear to increase overall risk, while separated or divorced participants had a significantly lower risk of mortality than those who were married or partnered.
  • Better lung function and moderate exercise were found to be protective against mortality.
  • The mortality risk of diabetic patients was modified by place of residence (north v west) and depression.

“All in all, the study highlights the need to address the social inequalities and strengthen behavioural interventions for the various subgroups of the population to prevent premature deaths,” says Flinders College of Medicine and Public Health researcher Dr Yohannes Adama Melaku,

“While it’s clear many subgroups in Western societies need more help to live healthier lives, we haven’t seen enough change in social interventions and health policies in key parts of our community in recent decades,” says Professor Robert Adams, from Flinders University’s College of Medicine and Public Health.

“There remains consistent evidence that lower household income and other socioeconomic considerations are strongly associated with a higher risk of mortality, particularly in participants under 65 years of age,” Professor Adams says.

The study was funded by the Hospital Research Foundation, Freemason’s Foundation Centre for Men’s Health, and the University of Adelaide.

Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year followup of the North West Adelaide Health Study by YA Melaku, TK Gill, SL Appleton, C Hill, MA Boyd and RJ Adams has been published in BMJ Open 2019;9(8):e030079.

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