Role of socioeconomic indicators in the prediction of all causes and coronary heart disease mortality in over 12,000 men ± The Italian RIFLE pooling project

The relationship of socioeconomic indica- tors (education, occupation and residence) to short- term all cause mortality and coronary heart disease (CHD) mortality was evaluated in an Italian popu- lation sample. Socioeconomic indicators (education, occupational level and residence) and major CHD risk factors were measured in 12,361 males aged 40± 69 years; mortality data by cause were collected for the next 6 years. All cause and CHD mortality risk ratio (RR) in the di erent educational and occupa- tional levels and residence were computed by Cox proportional hazards models. After 6 years 385 men died, of whom 105 were coronary fatalities. No as- sociation with educational level was found for all cause mortality (RR: 1.00 high, 0.71 medium, 0.77 low) and for CHD mortality (RR: 1.00 high, 0.39 intermediate, 0.71 low). Occupational level was sig- ni®cantly associated ( p < 0.031) with all cause mortality (RR: 1.00 high-intermediate, 1.27 low). Urban vs. rural residence (RR: 1.00) showed a RR for all cause mortality of 1.33 ( p < 0.011). Adjust- ment for bio-behavioral risk factors did not change the above results; only mortality for CHD of urban vs. rural residents increased (RR: 1.94, p = 0.004). In conclusion the negative association of mortality with occupational level, albeit not with education, indi- cates that occupation is a better indicator of socio- economic status in Italy. Status incongruity as well as residence in an urban environment could be risk conditions for total and CHD mortality.