Socioeconomic Factors, Health Behaviors, and Mortality

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Abstract
OVER THE PAST several decades, health behavior or lifestyle factors—smoking cigarettes, being overweight, drinking alcoholic beverages, and being physically inactive or leading a sedentary lifestyle—have often been cited as the major determinants of premature and preventable morbidity and mortality.1-7 More recently, differences in health outcomes by socioeconomic position have been recognized as a persisting and perhaps even increasing public health problem.8-12 Less well understood, however, is the relationship between health risk behaviors and socioeconomic differentials in health, especially in nationally representative samples. In a number of longitudinal studies, important socioeconomic indicators—such as income and education—have been shown to be inversely associated with various mortality outcomes, including premature mortality, cardiovascular mortality, and death from all causes.13-18 In addition, it is well documented that people of lower socioeconomic position are significantly more likely to lead a sedentary lifestyle, to be overweight, and to smoke cigarettes.19-22 Thus, a prominent hypothesis is that the elevated mortality risk associated with low levels of income and education is primarily due to the higher prevalence of health risk behaviors among people who are poor and/or have low educational attainment.3,23-25 However, previous efforts to explain socioeconomic differences in mortality in a variety of subpopulations have found that strong differences remain after controlling for major lifestyle risk factors.16,18,26-29

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