BACKGROUND Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors. METHODS Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education. RESULTS Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5 years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest. CONCLUSIONS These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.

中文翻译：

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减少全因死亡率中的社会经济不平等：反事实调解方法。

背景 死亡率方面的社会经济不平等已得到充分证实，但可能构成这些关系基础的中间风险因素的贡献仍不清楚。我们评估了社会经济相关死亡率背后的多个可修改中间风险因素的作用，并量化了通过假设改变社会经济风险因素来降低早期全因死亡率的潜在影响。方法 数据来自参与 LIFEPATH 联盟的七项队列研究（总人数 = 179 090）。使用社会经济地位 (SEP)（基于职业）和教育，我们估计了对全因死亡率的自然直接影响和通过吸烟、饮酒、饮食模式、身体活动的联合中介作用的自然间接影响，体重指数、高血压、糖尿病和冠状动脉疾病。在较低或较高 SEP 或教育的不同假设行为下，使用反事实自然效应模型估算了风险比 (HR)。结果 在 17.5 年的平均随访时间内，较低的 SEP 和受教育程度与全因死亡率增加有关。通过增加 SEP 或教育的模拟假设行动降低了死亡率。通过高等教育，与受教育程度较低的女性相比，HR 为 0.85 [95% 置信区间 (CI) 0.84, 0.86]，男性为 0.71 (95% CI 0.70, 0.74)。此外，女性和男性分别有 34% 和 38% 的影响是联合介导的。改变 SEP 的好处稍微小一些。